Kroger Limited Partnership I
Pharmacy, Community/Retail Pharmacy in Peoria, IL. Organization (NPI-2).
NPI number1710050331
StatusActive
Last updated in NPPESMay 18, 2016
Details
- NPI
- 1710050331
- Entity type
- Organization (NPI-2)
- Legal business name
- Kroger Limited Partnership I
- Organization subpart
- No
- Enumeration date
- Nov 15, 2006
- Last updated
- May 18, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 054011031 | IL | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Kroger Pharmacy (Doing Business As)
Practice location
3311 N Sterling AvePeoria, IL 61604-1840
Phone 309-679-2855 · Fax 309-679-2856
Mailing address
Po Box 842772Boston, MA 02284-2772
Phone 513-762-1019 · Fax 513-762-1092
Authorized official
Allison Muennich
Manager Of Pharmacy Licensing
5137621019
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