Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
Payless Pharmacy #338
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
715 S TILLOTSON AVE, MUNCIE, IN 47304-4526
(765) 213-1220
(765) 213-1225
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
60006671A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2176212
PK
—
Enumeration date
02/19/2018
Last updated
05/08/2018
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