Organization
KROGER TEXAS L P
Active
Other names
Kroger Pharmacy #594
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
3300 E BROAD ST, MANSFIELD, TX 76063-5629
(817) 435-5418
(817) 435-5420
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
27500
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2130481
PK
—
05
—
466751
—
TX
Enumeration date
05/24/2011
Last updated
05/16/2016
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