Organization
KROGER TEXAS LP
Active
Other names
Kroger Pharmacy #579
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA BONE (LICENSING ASP)
(513) 587-5303
Entity
Organization
Contact information
Practice address
500 MARKETPLACE BLVD, FORNEY, TX 75126-6740
(972) 564-8490
(972) 564-8492
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
28875
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1307140246
—
TX
01
—
2142258
PK
—
Enumeration date
09/24/2013
Last updated
05/30/2025
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