Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PS004006 Issued in MO

Legal business name

KROGER LIMITED PARTNERSHIP I

Doing business as

Kroger Pharmacy

Practice address

2770 N Westwood Blvd
Poplar Bluff, MO 63901-2345

Phone

(573) 686-6974

Fax

(573) 686-6975

NPI assigned

Jul 10, 2006

Last updated

Mar 13, 2020By 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

Jessie Warman

Title

Manager of Pharmacy Licensing

Phone

(513) 762-1090

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Troy, MO
  • NPI 1518030030

  O20090326000121

  Same enrollment

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

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

Kroger Pharmacy611 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 1

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Kroger Limited Partnership I

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Troy, MO
  • NPI 1518030030
  NPD tax ID

Member of 1

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

• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Pickerington, OH
  • NPI 1245255967

  Member Of

  NPD member

Locations

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.

• Malarie Blackwell, PHARMD

  • Pharmacist
  • Poplar Bluff, MO
  • NPI 1578102562
  NPD (past)
• Christina Dunivan, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Poplar Bluff, MO
  • NPI 1942849930
  NPD (past)
• Breanna Goostree, PHARMD

  • Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
  • Poplar Bluff, MO
  • NPI 1265079339
  NPD (past)
• Eric David Avila, PHARM.D.

  • Pharmacist
  • Lebanon, NH
  • NPI 1922372051
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1376577155",
    "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": "2770 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012345",
            "telephone_number": "573-686-6974",
            "fax_number": "573-686-6975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "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": "513-762-1090"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "PS004006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600130785",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2050246",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kramer Family Vision (InSight Eye)
• Edward Patrick Kreulen, FNP
• Charles S. Krin, D.O.
• Miranda Krishna, NP-C
• Balamurugan G Krishnan, M.D.
• Julianna Kuper
• Raghuveer Kura, M.D.
• Elizabeth Ann L'Heureux, APRN, FNP-BC, DNP
• Labone LLC
• Richard Ladka, RPH

• Community/Retail Pharmacy in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; 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.