Provider Demographics
NPI:1093858474
Name:THE KROGER CO
Entity Type:Organization
Organization Name:THE KROGER CO
Other - Org Name:KROGER PHARMACY ATLANTA DIVISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:WOOLF
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:513-762-4672
Mailing Address - Street 1:PO BOX 305227
Mailing Address - Street 2:KROGER PHARMACY ATLANTA
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-5227
Mailing Address - Country:US
Mailing Address - Phone:866-680-5133
Mailing Address - Fax:620-669-1898
Practice Address - Street 1:2700 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-1903
Practice Address - Country:US
Practice Address - Phone:866-680-5133
Practice Address - Fax:620-669-1898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3914102Medicare PIN
GAFLU346Medicare PIN
SCQ33397001Medicare PIN
GAFLU345Medicare PIN