1699709485 NPI number — KROGER LIMITED PARTNERSHIP I

Table of content: (NPI 1699709485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699709485 NPI number — KROGER LIMITED PARTNERSHIP I

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KROGER LIMITED PARTNERSHIP I
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
KROGER PHARMACY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699709485
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3631 PETERS CREEK RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROANOKE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24019-2809
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-563-3593
Provider Business Mailing Address Fax Number:
540-563-1436

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3032 E CUMBERLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUEFIELD
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
24701-4858
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-327-0823
Provider Business Practice Location Address Fax Number:
304-327-0828
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LANGWORTHY
Authorized Official First Name:
KARLA
Authorized Official Middle Name:
Authorized Official Title or Position:
PHARMACY LICENSING MANAGER
Authorized Official Telephone Number:
513-698-1878

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 552243 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0013178037 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5011440 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 008517592 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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