Kroger

Primary specialty

PharmacistTaxonomy code 183500000X

License

55682 Issued in TX

Legal business name

KROGER

Practice address

3600 Gus Thomasson Rd
Mesquite, TX 75150-6200

Phone

(972) 270-2401

Fax

(972) 613-2465

NPI assigned

Sep 26, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Richard Mendoza, PHARMD

Title

Pharmacist

Phone

(972) 270-2401

Specialties & licenses 1

Addresses

Tax ID family

Kroger Sav on J926319 organizations share this tax ID, including this one

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1443225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1443225600000",
    "number": "1356711873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 GUS THOMASSON RD",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506200",
            "telephone_number": "972-270-2401",
            "fax_number": "972-613-2465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 GUS THOMASSON RD",
            "city": "MESQUITE",
            "state": "TX",
            "postal_code": "751506200",
            "telephone_number": "972-270-2401",
            "fax_number": "972-613-2465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-26",
        "last_updated": "2015-09-26",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "972-270-2401",
        "authorized_official_credential": "PHARMD"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "55682",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald John Koepsell, D,O,
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• Diana R Koon, NP
• Finda Sebba Koroma, LVN
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Krystal Family Clinic LLC
• Krystal Family Psychiatry PLLC

• Pharmacist in Mesquite, TX
• Providers in Mesquite, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.