Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY #490
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
6745 S SIWELL RD, BYRAM, MS 39272-8747
(601) 863-2004
(601) 863-2016
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
6584012
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08627538
—
MS
01
—
2047210
PK
—
Enumeration date
07/10/2006
Last updated
05/16/2016
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