Organization
KROGER CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LESA WALLER (ENROLLMENT MANAGER)
(513) 387-8602
Entity
Organization
Contact information
Practice address
9968 E GRAND RIVER AVE, BRIGHTON, MI 48116-1924
(999) 999-9999
Mailing address
PO BOX 932958, CLEVELAND, OH 44193-0028
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
—
—
Other
Enumeration date
08/08/2024
Last updated
08/13/2024
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