The Kroger Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

3970RC Issued in LA

Legal business name

THE KROGER CO

Doing business as

Kroger Pharmacy

Practice address

1050 George Dement Blvd
Bossier City, LA 71111-5880

Phone

(318) 742-3509

Fax

(318) 742-7730

NPI assigned

Nov 15, 2006

Last updated

Jun 28, 2016By 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

Allison Muennich

Title

Manager of Pharmacy Licensing

Phone

(513) 762-1019

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in LA2 enrollments

Enrollment records 2

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

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

Kroger Pharmacy 253319 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

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

• Kroger Co

  • Community/Retail Pharmacy
  • Lake Charles, LA
  • NPI 1932647179
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Shreveport, LA
  • NPI 1164595682
  NPD tax ID
• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Alexandria, LA
  • NPI 1255404778
  NPD tax ID
• The Kroger Co

  dba Kroger Pharmacy #533

  • Community/Retail Pharmacy
  • Shreveport, LA
  • NPI 1548611288
  NPD tax ID
• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Sulphur, LA
  • NPI 1790858215
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Shreveport, LA
  • NPI 1982777405
  NPD tax ID

Locations

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467072000000",
    "number": "1073686598",
    "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",
            "fax_number": "513-762-1092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 GEORGE DEMENT BLVD",
            "city": "BOSSIER CITY",
            "state": "LA",
            "postal_code": "711115880",
            "telephone_number": "318-742-3509",
            "fax_number": "318-742-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2016-06-28",
        "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": "513-762-1019"
    },
    "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": "LA",
            "license": "3970RC",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2032156",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1233757",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Teer, MSN, FNP-C
• Lora P. Teutsch, LPC
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• Community/Retail Pharmacy in Bossier City, LA
• Providers in Bossier City, LA by specialty
• Community/Retail Pharmacy in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2016; 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.