Kroger Specialty Pharmacy, Inc.

Primary specialty

PharmacyTaxonomy code 333600000X

Legal business name

KROGER SPECIALTY PHARMACY, INC.

Practice address

1821 Kaiser Ave
Irvine, CA 92614-5707

Phone

(855) 733-3126

Fax

(888) 315-3270

NPI assigned

Jul 13, 2006

Organization subpart

No

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

Authorized official

Name

Debra J Cole

Title

Vice President

Phone

(855) 733-3126

Specialties & licenses 3

Addresses

Other identifiers 10

Other names 1

• Kroger Specialty Pharmacy CA 3 Doing business as

Member of 1

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

• The Kroger Co

  • Community/Retail Pharmacy
  • Woodstock, GA
  • NPI 1720012560

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Linh Youn, PHARMD

  • Pharmacist
  • Irvine, CA
  • NPI 1073936753
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588896000000",
    "number": "1184649782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 KAISER AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145707",
            "telephone_number": "855-733-3126",
            "fax_number": "888-315-3270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 KAISER AVE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926145707",
            "telephone_number": "855-733-3126",
            "fax_number": "888-315-3270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER SPECIALTY PHARMACY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-05-08",
        "certification_date": "2020-05-08",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "855-733-3126"
    },
    "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": true
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": "CA",
            "license": "PHY51548",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60000708",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "140622100",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184649782",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1626534",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94789061",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "092265",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2043938",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7176839",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184649782",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1184649782",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kroger Specialty Pharmacy CA 3",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Karla Kriz
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• Taylor Krone-Gonzalez
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• Adrienne Kruse
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• Pharmacy in Irvine, CA
• Providers in Irvine, CA by specialty
• Pharmacy in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.