Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MINEER (INTERFACE MANAGER)
(513) 387-7074
Entity
Organization
Contact information
Practice address
5615 W 38TH ST, INDIANAPOLIS, IN 46254-2921
(317) 299-6783
(317) 290-6404
Mailing address
5960 CASTLEWAY WEST DR, INDIANAPOLIS, IN 46250-1977
(317) 579-8434
(317) 579-8424
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005167
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100296920A
—
IN
01
—
1520750
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/15/2006
Last updated
06/24/2009
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