Organization
KROGER TEXAS LP
Active
Other names
Kroger Pharmacy #481
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
4836 W PARK BLVD, PLANO, TX 75093-2330
(972) 543-7923
(972) 543-7925
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
30544
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2155506
PK
—
05
—
469484
—
TX
Enumeration date
11/09/2015
Last updated
04/24/2017
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