Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Little Rock, AR
NPI 1417289166 · NPPES record last updated Jun 27, 2016
Key facts
- NPI
- 1417289166
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- AR20622 (AR)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 10300 N Rodney Parham Rd
Little Rock, AR 72227-4845 - Phone
- (501) 221-8301
- Fax
- (501) 221-8303
- NPI assigned
- Feb 5, 2010
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 19
Member of 1
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #582 |
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 AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930084906 | AR | DME Supplier - Pharmacy |
8224930136 | Practice locations: Little Rock, AR |
| O20101111000854 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 | Practice locations: Little Rock, AR |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Locations
10300 N Rodney Parham Rd
Little Rock, AR 72227
Phone (501) 221-8301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Community/Retail Pharmacy | 3336C0003X | AR20622 | AR | Yes |
Addresses
Primary practice location
10300 N Rodney Parham Rd
Little Rock, AR 72227-4845
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 180651407 | Medicaid | AR | |
| 2123654 | Other | PK |
Other names
- Kroger Pharmacy #582
Other providers in Little Rock, AR
- Melissa E Krisht
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
All providers in Little Rock, AR · Community/Retail Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 27, 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.