Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Lebanon, IN
NPI 1114090735 · NPPES record last updated Apr 22, 2025
Key facts
- NPI
- 1114090735
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60005173 (IN)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 2420 N Lebanon St
Lebanon, IN 46052-1183 - Phone
- (765) 482-7095
- Fax
- (765) 482-7480
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Member of 1
Practitioners 4
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0926172 | Kroger Pharmacy J 940 | Certificate of waiver | Mar 16, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #940 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080527000505 | IN | Part B Supplier - Pharmacy | 8224930136 | This NPI is an additional NPI on the enrollment |
| O20100930047317 | IN | DME Supplier - Pharmacy |
8224930136 | Practice locations: Lebanon, IN |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Locations
2420 N Lebanon St
Lebanon, IN 46052
Phone (765) 482-7021
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 60005173 | IN | Yes |
Addresses
Primary practice location
2420 N Lebanon St
Lebanon, IN 46052-1183
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2026676 | Other | PK | |
| 100294110A | Medicaid | IN |
Other names
- KROGER PHARMACY
Other providers in Lebanon, IN
- Jill Kristen Koenig
- Jackson Kouns
- Larry A Koval
- Daniel E Kraft
- Alyssa Marie Kregloh
- Meredith England Labrie
- Alan Joe Laclave
- Lacy Moser Boggs, OD, Inc
- Lafayette Emergency Physicians, Inc
- Lauren R. Laffoon
All providers in Lebanon, IN · Community/Retail Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.