Provider Demographics
NPI:1588423370
Name:THE KROGER CO
Entity type:Organization
Organization Name:THE KROGER CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF LICENSING
Authorized Official - Prefix:
Authorized Official - First Name:LYSETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEILHAMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-762-1090
Mailing Address - Street 1:PO BOX 842772
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-2772
Mailing Address - Country:US
Mailing Address - Phone:513-762-1090
Mailing Address - Fax:
Practice Address - Street 1:3942 HARPER FRANKLIN AVE.
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30309
Practice Address - Country:US
Practice Address - Phone:706-261-5210
Practice Address - Fax:706-261-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies