1689827479 NPI number — KROGER LIMITED PARTNERSHIP I

Table of content: (NPI 1689827479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689827479 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:
Provider Other Organization Name Type Code:
6
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:
1689827479
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2020
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:
635 CHESTNUT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41094-7841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-379-0030
Provider Business Practice Location Address Fax Number:
859-379-0031
Provider Enumeration Date:
10/24/2008

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: 3336C0003X , with the licence number:  P07299 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2117499 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100068000 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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