Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER PHARMACY LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
1161 E DAYTON YELLOW SPRINGS RD, FAIRBORN, OH 45324-6325
(937) 754-4427
(937) 754-4578
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
021135450
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2076514
PK
—
05
—
2160567
—
OH
Enumeration date
07/10/2006
Last updated
02/04/2020
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