Kroger Limited Partnership I, NPI 1164456893
Community/Retail Pharmacy in Memphis, TN, US

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NPI number: what is it?

The NPI, or National Provider Identifier, is a non-repeatable number for health care providers. The NPI always consists of 10 digits and is used for administrative and financial procedures. The NPI wa...

NPI 1164456893
NPI Entity Type Organization
Provider Name Kroger Limited Partnership I
Doing Business As
Enumeration Date September 30, 2009
Last Update Date September 30, 2009
Certification Date September 30, 2009
Provider Location Address 2632 Frayser Blvd, Memphis, TN, US
Provider Mailing Address Po Box 842772, Boston, MA, US, 022842772
Gender Male
Is Sole Proprietor? No
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Organization Official

Official Name Jessie Warman
Official Position MANAGER OF PHARMACY LICENSING
Phone 513-762-1090

Primary Taxonomy

Taxonomy Code

3336C0003X

Taxonomy Name Community/Retail Pharmacy
Classification

Pharmacy

Group

Suppliers

License No. C2988
License State TN
Description A pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Other Organization Name

KROGER PHARMACY #425
Doing Business As

Business Address

Kroger Limited Partnership I
2632 Frayser Blvd

Memphis, TN, US

Phone: 901-353-8284
Fax: 901-353-8285

Mailing Address

Kroger Limited Partnership I
Po Box 842772
Boston, MA, US
ZIP 022842772
Phone: 513-762-1019
Fax: 513-762-1092

Secondary Taxonomies

Taxonomy Code Group Classification License No. State Primary?

332B00000X

Suppliers

Durable Medical Equipment & Medical Supplies

No

333600000X

Suppliers

Pharmacy

No

Other Identifiers

Identifier Identifier State Identifier Issuer Type/Code
2091772 PK 01
4428911 TN MEDICAID 05

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NPI Name Taxonomy Address

1417615469

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FNP-BC Misty Renee Nichols

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MD Douglas Todd Cannon

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Taylor Woods

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MRS. PA-C Brittany C Smith

Individual

Physician Assistant

1265 Union Ave

Memphis, TN

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