Active NPI
Kroger Texas LP
- Community/Retail Pharmacy
- Spring, TX
National Provider Identifier
1033645635
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- KROGER TEXAS LP
- Practice address
- 2150 Spring Stuebner Rd
Spring, TX 77389-4813 - Phone
- (713) 507-6276
- Fax
- (713) 422-8031
- NPI assigned
- May 3, 2017
- Last updated
- Apr 20, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1263
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
2150 Spring Stuebner Rd
Spring, TX 77389-4813
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 471212 | Medicaid | TX | |
| 2169204 | Other | PK |
Other names 1
- Kroger Pharmacy #130
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041103001304 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 9638131303 | This NPI is an additional NPI on the enrollment |
| O20171024002346 | TX | DME Supplier - Pharmacy | 9638131303 | Practice locations: Spring, TX |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2134750 | Kroger Pharmacy #34-130 | Certificate of waiver | Aug 7, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #130 | 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 assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Kroger Texas
Organizations with this tax ID in the same state 19
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
dba Kroger Pharmacy
- Community/Retail Pharmacy
- North Richland Hills, TX
- NPI 1043383565
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Kroger Pharmacy
- Community/Retail Pharmacy
- Pickerington, OH
- NPI 1245255967
Member Of
Locations
2150 Spring Stuebner Rd
Spring, TX 77389
Phone (281) 602-0313
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1493769600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1524182400000",
"number": "1033645635",
"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": "2150 SPRING STUEBNER RD",
"city": "SPRING",
"state": "TX",
"postal_code": "773894813",
"telephone_number": "713-507-6276",
"fax_number": "713-422-8031"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER TEXAS LP",
"organizational_subpart": "NO",
"enumeration_date": "2017-05-03",
"last_updated": "2018-04-20",
"status": "A",
"authorized_official_last_name": "MUENNICH",
"authorized_official_first_name": "ALLISON",
"authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
"authorized_official_telephone_number": "513-762-1263"
},
"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": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "471212",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2169204",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kroger Pharmacy #130",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2018; 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.