1962545145 NPI number — KROGER LIMITED PARTNERSHIP I

Table of content: (NPI 1962545145)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962545145 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 DELTA DIVISION
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:
1962545145
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 305219
Provider Second Line Business Mailing Address:
KROGER PHARMACY DELTA
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37230-5219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-680-5133
Provider Business Mailing Address Fax Number:
620-669-1898

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 E 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67501-1903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-680-5133
Provider Business Practice Location Address Fax Number:
620-669-1898
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WOOLF
Authorized Official First Name:
WENDELL
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
513-762-4672

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336I0012X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10609 . This is a "MEDICARE MASS IMMUNIZER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3913544 . This is a "MEDICARE MASS IMMUNIZER" identifier . This identifiers is of the category "OTHER".




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