Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
KROGER PHARMACY J-888
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MINEER (INTERFACE MANAGER)
(513) 387-7074
Entity
Organization
Contact information
Practice address
201 E BIDWELL ST, TAYLORVILLE, IL 62568-1361
(217) 287-7391
(217) 287-7440
Mailing address
5960 CASTLEWAY WEST DR, INDIANAPOLIS, IN 46250-1977
(317) 579-8434
(317) 579-8424
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054015081
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1476452
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
11/15/2006
Last updated
12/14/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up