Active NPI
Kroger Limited Partnership I
- Community/Retail Pharmacy
- Portsmouth, VA
National Provider Identifier
1093124505
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 0201004598
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 1301 Frederick Blvd
Portsmouth, VA 23707-4123 - Phone
- (757) 337-5341
- Fax
- (757) 337-5343
- NPI assigned
- Aug 8, 2014
- 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) 762-1019
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0201004598 | VA | Primary |
Addresses
Primary practice location
1301 Frederick Blvd
Portsmouth, VA 23707-4123
Mailing address
P.O. Box 842772
Boston, MA 02284
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2147288 | Other | PK | |
| 1093124505 | Medicaid | VA |
Other names 1
- Kroger Pharmacy #542
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC, VA
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041115000087 | NC | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 |
14 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Durham, NC; Fuquay Varina, NC; Cary, NC; Apex, NC |
| O20050207000561 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 | This NPI is an additional NPI on the enrollment |
| O20141203001714 | VA | DME Supplier - Pharmacy | 8224930136 | Practice locations: Portsmouth, VA |
Other NPIs on the same Medicare enrollment 14
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Community/Retail Pharmacy
- Fuquay Varina, NC
- NPI 1588698377
O20041115000087
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 |
|---|---|---|---|
| 49D2086536 | Kroger Pharmacy #542 | Certificate of waiver | Nov 4, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #542 | 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 DirectoryMember 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": "1407456000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1758240000000",
"number": "1093124505",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 842772",
"city": "BOSTON",
"state": "MA",
"postal_code": "02284",
"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": "1301 FREDERICK BLVD",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237074123",
"telephone_number": "757-337-5341",
"fax_number": "757-337-5343"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER LIMITED PARTNERSHIP I",
"organizational_subpart": "NO",
"enumeration_date": "2014-08-08",
"last_updated": "2025-09-19",
"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": 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": "VA",
"license": "0201004598",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2147288",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1093124505",
"state": "VA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kroger Pharmacy #542",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Portsmouth, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2025; 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.