NPIMap

Organization Active NPI

Kroger Limited Partnership I

Doing business as Kroger Pharmacy #093

  • Community/Retail Pharmacy
  • Nashville, TN
National Provider Identifier
1003354861
Registry record updated Apr 25, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KROGER LIMITED PARTNERSHIP I
Doing business as
Kroger Pharmacy #093
Practice address
2694 Fessey CT
Nashville, TN 37204-2813
Phone
(615) 600-3854
Fax
(615) 600-3856
NPI assigned
Feb 1, 2017
Last updated
Apr 25, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2017

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

Authorized official

Name
Mendi Prow
Title
Pharmacy Licensing Asp
Phone
(513) 762-1263

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

2694 Fessey CT
Nashville, TN 37204-2813

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other identifiers 1

IdentifierTypeStateIssuer
2167579OtherPK

Other names 1

  • KROGER PHARMACY #093 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140523001287 TN Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alcoa, TN; Seymour, TN; Sevierville, TN; Pigeon Forge, TN; Oak Ridge, TN; Nashville, TN; Memphis, TN; Maryville, TN…
O20170607003003 TN DME Supplier - Pharmacy 8224930136 Practice locations: Nashville, TN

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2131095Kroger Pharmacy #26-0932694 Fessey Court, Nashville, TN 37204Certificate of waiverMay 22, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Limited Partnership I2694 Fessey CT, Nashville, TN 37204-2813(615) 600-3854 Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Commodes, Urinals, Bedpans|Blood Glucose Monitors/Supplies (Non-Mail Order)|Canes and/or Crutches|Walkers|Ostomy Supplies|Urological Supplies|Enteral Nutrients|Enteral Equipment and/or Supplies|Nebulizer Equipment a… Accepts assignmentParticipating since Aug 27, 2003

National Provider Directory

National Provider Directory
Tax ID family
Kroger Pharmacy 29209611 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1485907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493078400000",
    "number": "1003354861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842772",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022842772",
            "telephone_number": "513-762-1019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2694 FESSEY CT",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372042813",
            "telephone_number": "615-600-3854",
            "fax_number": "615-600-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-01",
        "last_updated": "2017-04-25",
        "status": "A",
        "authorized_official_last_name": "PROW",
        "authorized_official_first_name": "MENDI",
        "authorized_official_title_or_position": "PHARMACY LICENSING ASP",
        "authorized_official_telephone_number": "513-762-1263"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2167579",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY #093",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.