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  7. NPI Record 1558404798

KROGER PHARMACY MIDATLANTIC DIVISION
Complete NPI Record 1558404798
Pharmacy - Community/Retail Pharmacy in Hutchinson, KS

NPI Status: Active since February 15, 2007

Contact Information

2700 E 4TH AVE
HUTCHINSON, KS
ZIP 67501
Phone: (866) 680-5133
Fax: (620) 669-1898

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider Other Organization Name
  6. Provider Other Organization Name Type Code
  7. Provider First Line Business Mailing Address
  8. Provider Second Line Business Mailing Address
  9. Provider Business Mailing Address City Name
  10. Provider Business Mailing Address State Name
  11. Provider Business Mailing Address Postal Code
  12. Provider Business Mailing Address Country Code If outside U S
  13. Provider Business Mailing Address Telephone Number
  14. Provider Business Mailing Address Fax Number
  15. Provider First Line Business Practice Location Address
  16. Provider Business Practice Location Address City Name
  17. Provider Business Practice Location Address State Name
  18. Provider Business Practice Location Address Postal Code
  19. Provider Business Practice Location Address Country Code If outside U S
  20. Provider Business Practice Location Address Telephone Number
  21. Provider Business Practice Location Address Fax Number
  22. Provider Enumeration Date
  23. Last Update Date
  24. Authorized Official Last Name
  25. Authorized Official First Name
  26. Authorized Official Middle Name
  27. Authorized Official Title or Position
  28. Authorized Official Telephone Number
  29. Healthcare Provider Taxonomy Code 1
  30. Healthcare Provider Primary Taxonomy Switch 1
  31. Healthcare Provider Taxonomy Code 2
  32. Healthcare Provider Primary Taxonomy Switch 2
  33. Is Organization Subpart
  34. Authorized Official Name Prefix Text
  35. Authorized Official Credential Text

Complete NPI Dataset

This page represents the complete record for NPI 1558404798. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1558404798
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Entity Type Code: 2
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Employer Identification Number EIN: UNAVAIL
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Provider Other Organization Name: KROGER PHARMACY MIDATLANTIC DIVISION
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Provider Other Organization Name Type Code: 3
Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Provider First Line Business Mailing Address: PO BOX 305250
Provider Second Line Business Mailing Address: KROGER PHARMACY MIDATLANTIC
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No
Provider Business Mailing Address City Name: NASHVILLE
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: TN
The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code: 372305250
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 8666805133
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number: 6206691898
The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address: 2700 E 4TH AVE
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: HUTCHINSON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: KS
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 675011903
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S : US
The country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number: 8666805133
The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number: 6206691898
The fax number associated with the location address of the provider being identified.
Provider Enumeration Date: 2/15/2007
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 3/18/2008
The date that a record was last updated or changed.
Authorized Official Last Name: WOOLF
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First Name: WENDELL
The first name of the authorized official.
Authorized Official Middle Name: MARK
The middle name of the authorized official.
Authorized Official Title or Position: DIRECTOR OF PHARMACY
The title or position of the authorized official.
Authorized Official Telephone Number: 5137624672
The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1: 3336I0012X
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1: N
Healthcare Provider Taxonomy Code 2: 3336C0003X
Healthcare Provider Primary Taxonomy Switch 2: Y
Is Organization Subpart: N
Authorized Official Name Prefix Text: MR.
Authorized Official Credential Text: RPH