Organization
KROGER TEXAS L P
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KARLA LANGWORTHY (MANAGER OF PHARMACY CREDENTIALING)
(513) 698-1878
Entity
Organization
Contact information
Practice address
1420 E HIGHWAY 377, GRANBURY, TX 76048-2646
(817) 573-3745
(817) 573-7515
Mailing address
19245 DAVID MEMORIAL DR, SHENANDOAH, TX 77385-8778
(713) 507-6276
(936) 442-6704
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20215
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2096801
PK
—
05
—
464617
—
TX
Enumeration date
11/15/2006
Last updated
04/07/2014
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