Organization
KROGER TEXAS L P
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KARLA LANGWORTHY (MANAGER OF PHARMACY CREDENTIALING)
(513) 698-1878
Entity
Organization
Contact information
Practice address
1305 S HWY 121, LEWISVILLE, TX 75067-5915
(972) 436-1607
(972) 221-6838
Mailing address
19245 DAVID MEMORIAL DR, SHENANDOAH, TX 77385-8778
(713) 507-6276
(936) 442-6704
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
20136
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2096704
PK
—
05
—
464611
—
TX
Enumeration date
11/15/2006
Last updated
04/07/2014
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