Kroger Texas L P

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

20175 Issued in TX

Legal business name

KROGER TEXAS L P

Doing business as

Kroger Pharmacy

Practice address

1461 Spring Cypress Rd
Spring, TX 77373-2544

Phone

(281) 353-8204

Fax

(281) 353-6392

NPI assigned

Nov 15, 2006

Last updated

Jul 30, 2013By 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

Zach Stone

Title

Pharmacy Licensing Manager

Phone

(513) 762-1019

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

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

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375142400000",
    "number": "1376616805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19245 DAVID MEMORIAL DR",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773858778",
            "telephone_number": "713-507-6276",
            "fax_number": "936-442-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1461 SPRING CYPRESS RD",
            "city": "SPRING",
            "state": "TX",
            "postal_code": "773732544",
            "telephone_number": "281-353-8204",
            "fax_number": "281-353-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER TEXAS L P",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2013-07-30",
        "status": "A",
        "authorized_official_last_name": "STONE",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "PHARMACY LICENSING MANAGER",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "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": "TX",
            "license": "20175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2103167",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "464517",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bruce Samuel Kroeker, DPM
• Houkje Janna Marie Kroeze Stewart, SLP
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas Limited Partnership (Kroger Pharmacy)
• Kroger Texas LP

• Community/Retail Pharmacy in Spring, TX
• Providers in Spring, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.