Organization
KROGER CO OF MICHIGAN
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (MANAGER RX LICENSING)
(513) 762-1090
Entity
Organization
Contact information
Practice address
15251 23 MILE RD, MACOMB, MI 48042-4056
(586) 677-0968
(810) 677-9794
Mailing address
40399 GRAND RIVER AVE STE 110, NOVI, MI 48375-2148
(248) 536-1545
(248) 536-1599
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
5301007043
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2044503
PK
—
05
—
4119196
—
MI
Enumeration date
07/10/2006
Last updated
01/16/2019
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