Active NPI
Kroger Texas L P
Doing business as Kroger Pharmacy
- Community/Retail Pharmacy
- Plano, TX
National Provider Identifier
1114090644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 24065
- Legal business name
- KROGER TEXAS L P
- Doing business as
- Kroger Pharmacy
- Practice address
- 9617 Coit Rd
Plano, TX 75024-7203 - Phone
- (214) 705-9097
- Fax
- (214) 705-0260
- NPI assigned
- Nov 15, 2006
- Last updated
- Jun 2, 2025
- 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
- Victoria Bone
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 587-5303
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 24065 | TX | Primary |
Addresses
Primary practice location
9617 Coit Rd
Plano, TX 75024-7203
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other names 1
- KROGER PHARMACY
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 |
| O20100930084298 | TX | DME Supplier - Pharmacy | 9638131303 | Practice locations: Plano, 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.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #698 | 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 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
- Plano, TX
- NPI 1790325959
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Plano, TX
- NPI 1104466374
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1748822400000",
"number": "1114090644",
"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": "9617 COIT RD",
"city": "PLANO",
"state": "TX",
"postal_code": "750247203",
"telephone_number": "214-705-9097",
"fax_number": "214-705-0260"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER TEXAS L P",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-15",
"last_updated": "2025-06-02",
"certification_date": "2025-06-02",
"status": "A",
"authorized_official_last_name": "BONE",
"authorized_official_first_name": "VICTORIA",
"authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
"authorized_official_telephone_number": "513-587-5303"
},
"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": "TX",
"license": "24065",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.