Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60006088A Issued in IN

Legal business name

KROGER LIMITED PARTNERSHIP I

Doing business as

Scotts Pharmacy

Practice address

5725 Coventry LN
Fort Wayne, IN 46804-7146

Phone

(260) 434-0497

Fax

(260) 434-0518

NPI assigned

Jun 20, 2007

Last updated

Mar 3, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karla Langworthy, CPHT

Title

Pharmacy Licensing Manager

Phone

(513) 698-1878

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• SCOTTS PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Member of 1

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

• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Pickerington, OH
  • NPI 1245255967

  Member Of

  NPD member

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

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299110400000",
    "number": "1053516880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 CASTLEWAY WEST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501977",
            "telephone_number": "317-579-8434",
            "fax_number": "317-579-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5725 COVENTRY LN",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047146",
            "telephone_number": "260-434-0497",
            "fax_number": "260-434-0518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2011-03-03",
        "status": "A",
        "authorized_official_last_name": "LANGWORTHY",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "PHARMACY LICENSING MANAGER",
        "authorized_official_telephone_number": "513-698-1878",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006088A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1561578",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200872340A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCOTTS PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Indira D Krishnan, P.T.
• Krista Agler LLC
• Carter Owen Krizmanich
• Sandra A Krizmanich, MD
• Angela Kroemer, RN
• Kroger Limited Partnership I (Scotts Pharmacy J403)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Scotts Pharmacy J 410)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy)

• Community/Retail Pharmacy in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Community/Retail Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.