Provider Demographics
NPI:1528287364
Name:KROGER
Entity type:Organization
Organization Name:KROGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:BETH
Authorized Official - Last Name:RINGS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-654-2044
Mailing Address - Street 1:1735 N MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1634
Mailing Address - Country:US
Mailing Address - Phone:740-654-2044
Mailing Address - Fax:740-681-4069
Practice Address - Street 1:1735 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1634
Practice Address - Country:US
Practice Address - Phone:740-654-2044
Practice Address - Fax:740-681-4069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-0153550-07061183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0371173Medicaid
OH0302060064Medicare ID - Type Unspecified