Organization
KROGER LIMITED PARTNERSHIP I
Active
Other names
JAY C FOOD STORES
Organization subpart
No
Provider details
NPI number
Authorized official
JESSIE WARMAN (PHARMACY LICENSING MANAGER)
(513) 762-1090
Entity
Organization
Contact information
Practice address
9501 COUNTY ROAD 403, CHARLESTOWN, IN 47111-8939
(812) 256-6805
(812) 503-3180
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
60005913A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200808880A
—
IN
01
—
2025362
PK
—
Enumeration date
07/10/2006
Last updated
04/22/2025
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