Organization
KROGER TEXAS L P
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
1919 FAITHON P LUCAS SR BLVD, MESQUITE, TX 75181-1697
(469) 726-0013
(469) 726-0590
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
22264
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2097892
PK
—
05
—
465257
—
TX
Enumeration date
11/15/2006
Last updated
05/16/2016
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