Provider Demographics
NPI:1215188818
Name:KROGER TEXAS LP
Entity Type:Organization
Organization Name:KROGER TEXAS LP
Other - Org Name:KROGER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MERCHANDISER
Authorized Official - Prefix:
Authorized Official - First Name:BRYON
Authorized Official - Middle Name:
Authorized Official - Last Name:COOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-507-6276
Mailing Address - Street 1:PO BOX 677516
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-7516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10250 STATE HWY 6
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:77545
Practice Address - Country:US
Practice Address - Phone:713-507-6266
Practice Address - Fax:713-422-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5632066OtherNCPDP PROVIDER IDENTIFICATION NUMBER