Organization · NPI-2

Kroger Limited Partnership I

Pharmacy, Community/Retail Pharmacy · Greenville, MS

NPI number1487688263

StatusActive

Last updated in NPPESMar 13, 2020

Details

NPI: 1487688263
Entity type: Organization (NPI-2)
Legal business name: Kroger Limited Partnership I
Organization subpart: No
Enumeration date: Jul 10, 2006
Certification date: Mar 13, 2020
Last updated: Mar 13, 2020

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
3336C0003X	Pharmacy, Community/Retail Pharmacy	0296601KG	MS	Yes
333600000X	Pharmacy	–	–
332B00000X	Durable Medical Equipment & Medical Supplies	–	–

Other names

Kroger Pharmacy (Doing Business As)

Practice location

1778 Highway 1 S
Greenville, MS 38701-7801

Phone 662-332-0231 · Fax 662-332-0232

Mailing address

Po Box 842772
Boston, MA 02284-2772

Phone 513-762-1019 · Fax 513-762-1092

Authorized official

Jessie Warman
Manager Of Pharmacy Licensing
5137621090

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