NPIMap

Organization Active NPI

The Kroger Co

Doing business as Kroger Pharmacy

  • Community/Retail Pharmacy
  • Richmond Hill, GA
National Provider Identifier
1003840810
Registry record updated Sep 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
8330 Issued in GA
Legal business name
THE KROGER CO
Doing business as
Kroger Pharmacy
Practice address
9701 Ford Ave
Richmond Hill, GA 31324-6422
Phone
(912) 756-2255
Fax
(912) 756-2607
NPI assigned
Jul 10, 2006
Last updated
Sep 29, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2009

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

Authorized official

Name
Matt Mineer
Title
Interface Manager
Phone
(513) 387-7074

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 8330 GA Primary

Addresses

Primary practice location

9701 Ford Ave
Richmond Hill, GA 31324-6422

Mailing address

2175 Parklake Dr NE
Atlanta, GA 30345-2845
Phone (770) 496-5332

Other identifiers 2

IdentifierTypeStateIssuer
1146516OtherNCPDP PROVIDER IDENTIFICATION NUMBER
00839583AMedicaidGA

Other names 1

  • KROGER PHARMACY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kroger Pharmacy 957319 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

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

Locations

2175 Parklake Dr NE
Atlanta, GA 30345
Phone (770) 496-7400

9701 Ford Ave
Richmond Hill, GA 31324
Phone (912) 756-2255

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254182400000",
    "number": "1003840810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2175 PARKLAKE DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452845",
            "telephone_number": "770-496-5332",
            "fax_number": "770-496-7562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9701 FORD AVE",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313246422",
            "telephone_number": "912-756-2255",
            "fax_number": "912-756-2607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2009-09-29",
        "status": "A",
        "authorized_official_last_name": "MINEER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "INTERFACE MANAGER",
        "authorized_official_telephone_number": "513-387-7074"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "GA",
            "license": "8330",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1146516",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00839583A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond Hill, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2009; 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.