Organization
KROGER TEXAS L P
Active
Organization
KROGER TEXAS L P
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
20168 EVA ST, MONTGOMERY, TX 77356-2006
(936) 449-7167
(936) 449-7169
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
22219
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2097619
PK
—
05
—
465220
—
TX
Enumeration date
11/16/2006
Last updated
03/11/2019
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