Organization
THE KROGER CO
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER PHARMACY LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
3558 MAIN ST, WEIRTON, WV 26062-4508
(304) 748-6290
(304) 648-6292
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
MP0552282
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0013178042
—
WV
05
—
0015394000003
—
PA
01
—
2111422
PK
—
Enumeration date
07/13/2006
Last updated
02/04/2020
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