Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KARLA LANGWORTHY (MANAGER OF PHARMACY CREDENTIALING)
(513) 698-1878
Entity
Organization
Contact information
Practice address
2130 EXETER RD, GERMANTOWN, TN 38138-3922
(901) 754-7864
(901) 758-3632
Mailing address
800 RIDGE LAKE BLVD, MEMPHIS, TN 38120-9427
(901) 765-4157
(901) 765-4213
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
C1768
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2090105
PK
—
05
—
9449318
—
TN
Enumeration date
07/10/2006
Last updated
04/07/2014
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