Kroger Texas L P

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

27860 Issued in TX

Legal business name

KROGER TEXAS L P

Practice address

4901 Maple Ave
Dallas, TX 75235-8210

Phone

(972) 725-1270

Fax

(972) 725-1277

NPI assigned

Dec 29, 2011

Organization subpart

No

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 2

Addresses

Other identifiers 2

Other names 1

• Kroger Pharmacy Doing business as

Medicare fee-for-service enrollment

Enrolled in TX2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

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

Practitioners 3

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

• Whitney Faith Barth, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Dallas, TX
  • NPI 1093314049
  NPD (past)
• Oscar Alberto Beltran, PHARM.D

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Dallas, TX
  • NPI 1336743830
  NPD (past)
• Nicole Ruszkowski, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Dallas, TX
  • NPI 1447881065
  NPD (past)

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

{
    "created_epoch": "1325116800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1265701742",
    "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": "4901 MAPLE AVE",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752358210",
            "telephone_number": "972-725-1270",
            "fax_number": "972-725-1277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER TEXAS L P",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-29",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "27860",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2133247",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "466797",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kroger Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristen Casenave, MD, PA
• Kristine Tawater
• Olivia Kroeger
• Kroger Texas L P
• Kroger Texas L P
• Kroger Texas L P
• Kroger Texas L P
• Kroger Texas L P
• Kroger Texas L P
• Kroger Texas L P

• Community/Retail Pharmacy in Dallas, TX
• Providers in Dallas, TX by specialty
• Community/Retail Pharmacy in Texas

• 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.

Verify at the official NPI Registry.