NPIMap

Organization Active NPI

Kroger Co of Michigan

  • Community/Retail Pharmacy
  • Rochester Hills, MI
National Provider Identifier
1366476129
Registry record updated Jan 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
5301005249 Issued in MI
Legal business name
KROGER CO OF MICHIGAN
Practice address
65 S Livernois Rd
Rochester Hills, MI 48307-6901
Phone
(248) 652-4750
Fax
(248) 652-1961
NPI assigned
Jul 10, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Jessie Warman
Title
Manager RX Licensing
Phone
(513) 762-1090

Practitioners 2

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2076891The Kroger Co of Michigan65 S Livernois, Rochester, MI 48307Certificate of waiverApr 28, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Co of Michigan65S Livernois Rd, Rochester Hills, MI 48307-6901(248) 652-4750 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 assignmentParticipating since Nov 5, 2020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041110000810 MI Part B Supplier - Mass Immunization (Roster Biller Only) 8820051816 This NPI is an additional NPI on the enrollment
O20100930017482 MI DME Supplier - PharmacyDME Supplier - Grocery Store 8820051816 Practice locations: Rochester Hills, MI

National Provider Directory

National Provider Directory
Tax ID family
Kroger Co of Michigan106 organizations share this tax ID, including this one

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.

View all 24

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 5301005249 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

65 S Livernois Rd
Rochester Hills, MI 48307-6901

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1090

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
2040689OtherPK
2634207MedicaidMI

Other names 1

NPPES NPI Registry
  • KROGER PHARMACY Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 16, 2019.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1547596800000",
    "number": "1366476129",
    "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": "513-762-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 S LIVERNOIS RD",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483076901",
            "telephone_number": "248-652-4750",
            "fax_number": "248-652-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER CO OF MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2019-01-16",
        "status": "A",
        "authorized_official_last_name": "WARMAN",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "MANAGER RX LICENSING",
        "authorized_official_telephone_number": "513-762-1090"
    },
    "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": "MI",
            "license": "5301005249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2040689",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2634207",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester Hills, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2019; 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.