Organization · NPI-2

Kroger Limited Partnership I

Pharmacy, Community/Retail Pharmacy · Beavercreek, OH

NPI number1013941723

StatusActive

Last updated in NPPESFeb 4, 2020

Details

NPI: 1013941723
Entity type: Organization (NPI-2)
Legal business name: Kroger Limited Partnership I
Organization subpart: No
Enumeration date: Jul 10, 2006
Certification date: Feb 4, 2020
Last updated: Feb 4, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
3336C0003X	Pharmacy, Community/Retail Pharmacy	021085200	OH	Yes
332B00000X	Durable Medical Equipment & Medical Supplies	–	–
333600000X	Pharmacy	–	–

Other names

Kroger Pharmacy (Doing Business As)

Practice location

3165 Dayton Xenia Rd
Ste 5
Beavercreek, OH 45434-6309

Phone 937-431-8230 · Fax 937-431-8226

Mailing address

Po Box 842772
Boston, MA 02284-2772

Phone 513-762-1019 · Fax 513-762-1092

Authorized official

Jessie Warman
Manager Pharmacy Licensing
5137621090

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.