Organization
THE KROGER CO
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
1240 PARK AVE W, MANSFIELD, OH 44906-2814
(419) 528-1862
(419) 528-1864
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
021458650
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2079954
PK
—
05
—
2518896
—
OH
Enumeration date
07/10/2006
Last updated
04/21/2025
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