Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60006079A Issued in IN

Legal business name

KROGER LIMITED PARTNERSHIP I

Doing business as

Scotts Pharmacy J403

Practice address

710 E Dupont Rd
Fort Wayne, IN 46825-2056

Phone

(260) 489-2878

Fax

(260) 490-2421

NPI assigned

Jun 13, 2007

Last updated

Jul 26, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karla Langworthy, CPHT

Title

Pharmacy Licensing Manager

Phone

(513) 698-1878

Specialties & licenses 1

Addresses

Other names 1

• SCOTTS PHARMACY J403 Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

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

{
    "created_epoch": "1181692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280102400000",
    "number": "1275737355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 CASTLEWAY WEST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501977",
            "telephone_number": "317-579-8434",
            "fax_number": "317-579-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 E DUPONT RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252056",
            "telephone_number": "260-489-2878",
            "fax_number": "260-490-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-13",
        "last_updated": "2010-07-26",
        "status": "A",
        "authorized_official_last_name": "LANGWORTHY",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "PHARMACY LICENSING MANAGER",
        "authorized_official_telephone_number": "513-698-1878",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006079A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCOTTS PHARMACY J403",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Krista Agler LLC
• Carter Owen Krizmanich
• Sandra A Krizmanich, MD
• Angela Kroemer, RN
• Kroger Limited Partnership I (Scotts Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Scotts Pharmacy J 410)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy #425)

• Community/Retail Pharmacy in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Community/Retail Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.