Organization
THE KROGER CO
Active
Other names
KROGER PHARMACY #641
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
774 GA HIGHWAY 96, BONAIRE, GA 31005-3300
(478) 988-5710
(478) 988-5720
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009609
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2122255
PK
—
05
—
989904790A
—
GA
Enumeration date
10/08/2009
Last updated
09/15/2016
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