Organization
THE KROGER CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
5550 BETHELVIEW RD, CUMMING, GA 30040
(678) 456-4054
(678) 456-4058
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176998
PK
—
Enumeration date
04/06/2018
Last updated
07/27/2018
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