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
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