Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Nicholasville, KY
NPI 1336173152 · NPPES record last updated Sep 29, 2016
Key facts
- NPI
- 1336173152
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 6278 (KY)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 995 S Main St
Nicholasville, KY 40356-2151 - Phone
- (859) 881-9086
- Fax
- (859) 887-4362
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Member of 1
Practitioners 4
-
Jeremy Burns, PHARMD
-
Carrie Danielle Davis, PHARMD
-
Shelley Elane Nall, PHARMD, LDE
-
Lisa Nelson, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 18D2000579 | Kroger Pharmacy L-713 | Certificate of waiver | Dec 2, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy L-713 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050422000416 | KY | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 | This NPI is an additional NPI on the enrollment |
| O20100930091039 | KY | DME Supplier - Pharmacy |
8224930136 | Practice locations: Nicholasville, KY |
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 | 6278 | KY | Yes |
Addresses
Primary practice location
995 S Main St
Nicholasville, KY 40356-2151
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2032435 | Other | PK | |
| 54032362 | Medicaid | KY |
Other names
- KROGER PHARMACY
Other providers in Nicholasville, KY
- Nathan Ryan Koslakiewicz
- Sharat Koul
- Jennifer Ann Kouns
- Kpa LLC
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Stacey Nichole Kroggel
- Deborah Martin Lainhart
- Amanda Jeanine Lamb
- Lauren Marie Cass Lane
All providers in Nicholasville, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 29, 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.