Organization
THE KROGER CO
Active
Other names
Kroger Pharmacy #626
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER OF PHARMACY LICENSING)
(513) 762-1263
Entity
Organization
Contact information
Practice address
2452 MOROSGO WAY NE, ATLANTA, GA 30324
(404) 946-0450
(404) 946-0451
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
PHRE010314
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003181373A
—
GA
01
—
2164511
PK
—
Enumeration date
10/05/2016
Last updated
04/21/2025
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