Organization
KROGER TEXAS L P
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
2303 BOONVILLE RD, BRYAN, TX 77808-2232
(979) 774-8377
(979) 774-8362
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
(513) 762-1092
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20285
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1247502
—
LA
01
—
2102717
PK
—
05
—
464658
—
TX
Enumeration date
11/15/2006
Last updated
05/16/2016
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