Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
SCOTTS PHARMACY J 404
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MINEER CPHT (INTERFACE MANAGER)
(513) 387-7074
Entity
Organization
Contact information
Practice address
5300 DECATUR RD, FORT WAYNE, IN 46806-3058
(260) 458-0840
(260) 458-9302
Mailing address
5960 CASTLEWAY WEST DR, INDIANAPOLIS, IN 46250-1977
(317) 579-8434
(317) 579-8424
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
60006086A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1561542
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
200872420A
—
IN
Enumeration date
06/20/2007
Last updated
06/24/2009
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