Provider Demographics
NPI:1801939236
Name:KROGER TEXAS LP
Entity type:Organization
Organization Name:KROGER TEXAS LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 415000
Mailing Address - Street 2:MSC 410646 KROGER SOUTHWEST PHARMACY
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37241-5000
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:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0430Medicare PIN
TXPH0427Medicare PIN
LAZ5CN46Medicare PIN
LAZ5CN48Medicare PIN
TXPH0431Medicare PIN
TXPH0425Medicare PIN
TXPH0429Medicare PIN
LAZ5CN47Medicare PIN
LAZ5CN43Medicare PIN
LAZ5CN44Medicare PIN
LAZ5CN45Medicare PIN
TXPH0426Medicare PIN
TXPH0428Medicare PIN
LAZ5CN49Medicare PIN