Organization
KROGER CO OF MICHIGAN
Active
Other names
Kroger Pharmacy #743
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
2200 E 12 MILE RD, ROYAL OAK, MI 48067-1504
(248) 397-1530
(248) 397-1532
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
5301011042
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750837670
—
MI
01
—
2163907
PK
—
Enumeration date
08/31/2016
Last updated
01/17/2017
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