Organization
THE KROGER CO
Active
Other names
Kroger Pharmacy #625
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
461 S COLUMBIA AVE, RINCON, GA 31326
(912) 826-7665
(912) 826-7667
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003175280A
—
GA
01
—
2157520
PK
—
Enumeration date
01/13/2016
Last updated
07/20/2018
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