Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · N Little Rock, AR
NPI 1295895274 · NPPES record last updated May 16, 2016
Key facts
- NPI
- 1295895274
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 0420103 (AR)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 6929 JFK Blvd
N Little Rock, AR 72116-5312 - Phone
- (501) 835-6530
- Fax
- (501) 835-6531
- NPI assigned
- Dec 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Other NPIs on the same Medicare enrollment 27
Corporate family (same tax ID) 23
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 04D1021911 | Kroger Pharmacy #642 | Certificate of waiver | Feb 2, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930078461 | AR | DME Supplier - Pharmacy |
8224930136 | Practice locations: N Little Rock, AR |
| O20120807000530 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 |
28 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Little Rock, AR; Maumelle, AR; N Little Rock, AR; North Little Rock, AR; Russellville, AR; West Memphis, AR; Conway, AR; Blythville, AR… |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0420103 | AR | Yes |
Addresses
Primary practice location
6929 JFK Blvd
N Little Rock, AR 72116-5312
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140030407 | Medicaid | AR | |
| 1992724 | Other | PK |
Other names
- KROGER PHARMACY
Other providers in N Little Rock, AR
- JM Professionals, in
- Amber N Johnson
- Yomika L Johnson
- Sheri Jones
- Kammy Marie Krisell
- Kroger Limited Partnership I
- Jordan Lancaster
- Govinda Prasad Lohani
- Lyndro Enterprises LLC
- Susan Kay Martin
All providers in N Little Rock, AR · Community/Retail Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2016. 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.