Active NPI
The Kroger Co
Doing business as Kroger Pharmacy #625
- Community/Retail Pharmacy
- Rincon, GA
National Provider Identifier
1306202890
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- Legal business name
- THE KROGER CO
- Doing business as
- Kroger Pharmacy #625
- Practice address
- 461 S Columbia Ave
Rincon, GA 31326 - Phone
- (912) 826-7665
- Fax
- (912) 826-7667
- NPI assigned
- Jan 13, 2016
- Last updated
- Jul 20, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jessie Warman
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | Primary |
Addresses
Primary practice location
461 S Columbia Ave
Rincon, GA 31326
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other names 1
- Kroger Pharmacy #625
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090227000285 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6103738653 | This NPI is an additional NPI on the enrollment |
| O20160630002482 | GA | DME Supplier - Pharmacy | 6103738653 | Practice locations: Rincon, GA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2129427 | Kroger Pharmacy # 625 | Certificate of waiver | Apr 18, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| The Kroger Co | 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 assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Kroger Pharmacy 253
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.
Practitioners & affiliated clinicians
Practitioners 4
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.
-
- Pharmacist
- Rincon, GA
- NPI 1932706686
-
- Pharmacist
- Rincon, GA
- NPI 1255939088
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Rincon, GA
- NPI 1821629643
-
- Pharmacist
- Hilton Head, SC
- NPI 1992429260
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1452643200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1532044800000",
"number": "1306202890",
"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": "461 S COLUMBIA AVE",
"city": "RINCON",
"state": "GA",
"postal_code": "31326",
"telephone_number": "912-826-7665",
"fax_number": "912-826-7667"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE KROGER CO",
"organizational_subpart": "NO",
"enumeration_date": "2016-01-13",
"last_updated": "2018-07-20",
"status": "A",
"authorized_official_last_name": "WARMAN",
"authorized_official_first_name": "JESSIE",
"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": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Kroger Pharmacy #625",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Kroger Pharmacy #625",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rincon, GA
- Sunrise Physical Therapy LLC
- Jessica Warner Swindell, FNP
- Tattnall Hospital Company LLC (Optim Medical Center Tattnall Rincon)
- Richard Alan Taylor, DMD
- Andrew R Tee VI, MD
- The New Breath Counseling Center, Inc
- The Urgent Care Center of Richmond Hill, LLC (Expercare Rincon)
- Laura Ann Thomas, LCPC, LPC
- Tyler Thompkins
- Thompson Chiropractic and Wellness Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2018; 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.