Organization
KROGER TEXAS LP
Active
Other names
Kroger Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
4241 CAPITOL AVE, DALLAS, TX 75204-3635
(972) 338-3101
(972) 338-3103
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
28134
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1307140243
—
TX
01
—
2135969
PK
—
Enumeration date
07/11/2012
Last updated
05/16/2016
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