NPIMap

Organization Active NPI

Kroger Co

Doing business as Kroger Drugstore #622

  • Community/Retail Pharmacy
  • Bethlehem, GA
National Provider Identifier
1154294205
Registry record updated Sep 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KROGER CO
Doing business as
Kroger Drugstore #622
Practice address
995 Loganville Highway
Bethlehem, GA 30620
Phone
(470) 900-2960
Fax
(470) 900-2961
NPI assigned
Sep 25, 2025
Last updated
Sep 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lysette Seilhamer
Title
Manager of Licensing
Phone
(513) 762-1090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

995 Loganville Highway
Bethlehem, GA 30620

Mailing address

PO Box 830242
Philadelphia, PA 19183-0352

Other names 1

  • Kroger Drugstore #622 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090227000285 GA Part B Supplier - Mass Immunization (Roster Biller Only) 6103738653 This NPI is an additional NPI on the enrollment
O20260114002103 GA DME Supplier - Pharmacy 6103738653 Practice locations: Bethlehem, GA

Laboratory certificates & supplier records

Derived by NPIMap

These 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

SupplierSuppliesMedicare assignment
Kroger Co995 Loganville Hwy, Bethlehem, GA 30620(470) 900-2960 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 assignmentParticipating since Oct 18, 2023

National Provider Directory

National Provider Directory
Tax ID family
Kroger Pharmacy 957319 organizations share this tax ID, including this one

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.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations (25 of 376)

300 N Dean Rd
Ste F
Auburn, AL 36830
Phone (334) 821-1717

1101 Beltline Rd SE
Decatur, AL 35601
Phone (256) 350-2572

2009 Drake Ave SW
Huntsville, AL 35801
Phone (256) 650-5982

6070 Moores Mill Rd
Huntsville, AL 35811
Phone (256) 852-4267

8404 Memorial Pkwy SW
Huntsville, AL 35802
Phone (256) 881-6481

1515 2nd Ave
Ste B
Opelika, AL 36801
Phone (334) 749-9096

2450 Enterprise Dr
Opelika, AL 36801
Phone (334) 737-2650

1720 Mars Hill Rd NW
Acworth, GA 30101
Phone (770) 419-5495

6199 Highway 92
Ste 176
Acworth, GA 30102
Phone (770) 924-9105

12460 Crabapple Rd
Alpharetta, GA 30004
Phone (678) 762-0574

12460 Crabapple Rd
#415
Alpharetta, GA 30004
Phone (770) 740-2060

12870 Highway 9 N
Alpharetta, GA 30004
Phone (770) 772-0699

5665 Highway 9 N
#444
Alpharetta, GA 30004
Phone (770) 752-5388

1720 Epps Bridge Pkwy
Athens, GA 30606
Phone (706) 583-8906

191 Alps Rd
Athens, GA 30606
Phone (706) 543-3553

1160 Moreland Ave SE
Atlanta, GA 30316
Phone (404) 624-8115

1160 Moreland Ave SE
#488
Atlanta, GA 30316
Phone (404) 624-8115

1225 Caroline St NE
Atlanta, GA 30307
Phone (404) 880-4109

1700 Monroe Dr NE
#298
Atlanta, GA 30324
Phone (404) 872-0785

1715 Howell Mill Rd NW
#346
Atlanta, GA 30318
Phone (404) 355-7889

2175 Parklake Dr NE
#649
Atlanta, GA 30345
Phone (770) 496-5314

2175 Parklake Dr NE
Ste 460
Atlanta, GA 30345
Phone (770) 496-5314

2452 Morosgo Way NE
Atlanta, GA 30324
Phone (404) 946-0450

3330 Piedmont Rd NE
#259
Atlanta, GA 30305
Phone (404) 233-9484

3425 Cascade Rd SW
Atlanta, GA 30311
Phone (404) 505-7802

Practitioners & affiliated clinicians

Practitioners 882

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.

View all 882

NPI Registry JSON

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

{
    "created_epoch": "1758758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758758400000",
    "number": "1154294205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 830242",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191830352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "995 LOGANVILLE HIGHWAY",
            "city": "BETHLEHEM",
            "state": "GA",
            "postal_code": "30620",
            "telephone_number": "470-900-2960",
            "fax_number": "470-900-2961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-09-25",
        "last_updated": "2025-09-25",
        "certification_date": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "SEILHAMER",
        "authorized_official_first_name": "LYSETTE",
        "authorized_official_title_or_position": "MANAGER OF LICENSING",
        "authorized_official_telephone_number": "513-762-1090"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kroger Drugstore #622",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bethlehem, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 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.

Verify at the official NPI Registry.