Organization
THE KROGER CO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON BREDESTEGE (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
6652 YOUREE DR, SHREVEPORT, LA 71105-4630
(318) 795-9966
(318) 795-0510
Mailing address
PO BOX 842772, BOSTON, MA 02284-2772
(513) 762-1019
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
3973RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1233765
—
LA
01
—
2033708
PK
—
Enumeration date
11/15/2006
Last updated
03/15/2018
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