Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW FELTMAN (MGR PHARMACY INTERFACE)
(513) 762-1095
Entity
Organization
Contact information
Practice address
537 S REED RD, KOKOMO, IN 46901-5692
(765) 454-5289
(765) 454-5296
Mailing address
1014 VINE ST, CINCINNATI, OH 45202-1141
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
60005159
IN
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100297430A
—
IN
01
—
1525522
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
256660
MEDICARE PTAN
—
Enumeration date
11/16/2006
Last updated
10/11/2008
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