Organization
KROGER CO OF MICHIGAN
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER RX LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
20422 MACK AVE, GROSSE POINTE, MI 48236-1676
(313) 308-1033
(313) 308-1036
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1090
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
5301008652
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2042701
PK
—
05
—
2370017
—
MI
Enumeration date
07/19/2007
Last updated
01/16/2019
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