Organization
KROGER SPECIALTY PHARMACY FL 2 LLC
Active
Other names
KROGER SPECIALTY PHARMACY FL 2
Organization subpart
No
Provider details
NPI number
Authorized official
DEBRA J COLE (VICE PRESIDENT)
(855) 733-3126
Entity
Organization
Contact information
Practice address
6435 HAZELTINE NATIONAL DR STE 140, ORLANDO, FL 32822-5156
(855) 274-1694
(855) 819-6922
Mailing address
6435 HAZELTINE NATIONAL DR STE 140, ORLANDO, FL 32822-5156
(855) 274-1694
(855) 819-6922
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
Primary
PH25629
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003131027A
—
GA
05
—
003131027B
—
GA
05
—
004264400
—
FL
05
—
004264401
—
FL
05
—
0212596
—
IA
05
—
0406827
—
MT
05
—
0406939
—
MT
05
—
0506711
—
NJ
05
—
0518565
—
NJ
05
—
097296
—
AZ
05
—
100264920-00
—
NE
05
—
1025997
—
VT
05
—
103011190-0001
—
PA
01
—
15-17-CC-9559
KENTUCKY (CHILDREN WITH SPECIAL HEALTH CARE NEEDS)
KY
05
—
150015500
—
MD
01
—
1508146010
FLORIDA CHILDREN'S MEDICAL SERVICES
FL
01
—
1508146010
INDIANA CHILDREN'S SPECIAL HEALTH CARE SERVICES PROGRAM
IN
05
—
1508146010
—
ID
05
—
1508146010
—
MI
05
—
1508146010
—
MN
05
—
1508146010
—
MO
05
—
1508146010
—
NC
05
—
1508146010
—
NV
05
—
1508146010
—
UT
05
—
1508146010
—
VA
05
—
1508146010
—
WI
05
—
16221397
—
NM
05
—
163522375
—
FL
01
—
18-20-CC-9559
KENTUCKY (CHILDREN WITH SPECIAL HEALTH CARE NEEDS)
KY
01
—
200590550A
OKLAHOMA (P) CHILDREN WITH SPECIAL HEALTHCARE NEEDS PROGRAM VENDOR
OK
01
—
201116160A
KANSAS (QMB)
KS
01
—
201116160B
KANSAS (P) (CHILDREN WITH SPECIAL HEALTHCARE NEEDS)
KS
05
—
201121900A
—
IN
05
—
2049652
—
VA
01
—
2131644
PK
—
05
—
216017
—
AL
05
—
27828701
—
NM
05
—
3102337
—
NH
05
—
3106044
—
NH
05
—
500686927
—
OR
05
—
500687694
—
OR
05
—
64770109
—
CO
01
—
7100257570
KENTUCKY (P), PASSPORT HEALTH PLAN, WELLCARE OF KENTUCKY
KY
05
—
7F5629
—
SC
05
—
DM1542
—
SC
01
—
Q036221
IDAHO (P) (CHILDREN WITH SPECIAL HEALTHCARE NEEDS)
ID
05
—
Q036221
—
TN
Enumeration date
08/29/2011
Last updated
09/30/2020
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