Organization
KROGER CO OF MICHIGAN
Active
Other names
KROGER PHARMACY #618
Organization subpart
No
Provider details
NPI number
Authorized official
ALLISON MUENNICH (MANAGER OF PHARMACY LICENSING)
(513) 762-1019
Entity
Organization
Contact information
Practice address
30935 FIVE MILE RD, LIVONIA, MI 48154-3600
(734) 422-3784
(734) 261-7369
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
5301005427
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2041019
PK
—
05
—
2668798
—
MI
Enumeration date
07/10/2006
Last updated
05/16/2016
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