1760416556 NPI number — THE KROGER CO

Table of content: (NPI 1760416556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760416556 NPI number — THE KROGER CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE KROGER CO
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:
1760416556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 842772
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02284-2772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-762-1019
Provider Business Mailing Address Fax Number:
513-762-1092

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLSBURG
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26070-1161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-243-6230
Provider Business Practice Location Address Fax Number:
304-243-6232
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WARMAN
Authorized Official First Name:
JESSIE
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER PHARMACY LICENSING
Authorized Official Telephone Number:
513-762-1090

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: MP0552310 , 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: 0013178049 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2111504 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2502956 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com