Organization
KROGER TEXAS L P
Active
Other names
KROGER PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
KARLA LANGWORTHY (PHARMACY LICENSING MANAGER)
(513) 698-1878
Entity
Organization
Contact information
Practice address
1050 BRIDGEWOOD DR, FORT WORTH, TX 76112-0802
(817) 446-6673
(817) 446-4943
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
20314
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4596144
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
464651
—
TX
Enumeration date
11/15/2006
Last updated
09/07/2010
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