Active NPI
The Kroger Co
Doing business as Kroger Pharmacy
- Community/Retail Pharmacy
- Acworth, GA
National Provider Identifier
1093749822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 7252
- Legal business name
- THE KROGER CO
- Doing business as
- Kroger Pharmacy
- Practice address
- 3330 Cobb Pkwy NW
Acworth, GA 30101-8320 - Phone
- (770) 975-8776
- Fax
- (770) 975-4326
- NPI assigned
- Jul 10, 2006
- Last updated
- May 16, 2016
- 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 | 7252 | GA | Primary |
Addresses
Primary practice location
3330 Cobb Pkwy NW
Acworth, GA 30101-8320
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2017520 | Other | PK | |
| 00444969A | Medicaid | GA |
Other names 1
- KROGER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090227000285 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6103738653 | This NPI is an additional NPI on the enrollment |
| O20100930038720 | GA | DME Supplier - Pharmacy | 6103738653 | Practice locations: Acworth, GA |
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 |
|---|---|---|---|
| 11D0983372 | Kroger Pharmacy #397 | Certificate of waiver | Sep 14, 2026 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #397 | 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 Pharmacy 253
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Acworth, GA
- NPI 1003083528
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Acworth, GA
- NPI 1932730710
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": "1463356800000",
"number": "1093749822",
"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": "3330 COBB PKWY NW",
"city": "ACWORTH",
"state": "GA",
"postal_code": "301018320",
"telephone_number": "770-975-8776",
"fax_number": "770-975-4326"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE KROGER CO",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-10",
"last_updated": "2016-05-16",
"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": "GA",
"license": "7252",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2017520",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00444969A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Acworth, GA
- Dipa Sharma Thakkar, D.D.S.
- Lindsay Nicole Thaxton, PHD, LPC, CPCS
- Richard John Thaxton III, MA, LPC
- The Art of Behavioral Design, LLC
- The Hopequest Ministry Group, Inc.
- The Kroger Co (Kroger Pharmacy)
- The Kroger Co (Kroger Pharmacy)
- The Payne Center PC
- The Village ABA Services LLC
- The Weston Group Inc. (The Weston Health Care Group Inc)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.