Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY #328
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
1664 E STONE DR, KINGSPORT, TN 37660-4663
(423) 392-0593
(423) 392-4094
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
C2928
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008513881
—
VA
05
—
1455052
—
TN
01
—
2091660
PK
—
Enumeration date
07/10/2006
Last updated
03/13/2018
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