Kroger Co of Michigan
Organization Active NPI Community/Retail Pharmacy · Grand Blanc, MI
NPI 1477587236 · NPPES record last updated Jan 25, 2019
Key facts
- NPI
- 1477587236
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 5301007124 (MI)
- Legal business name
- KROGER CO OF MICHIGAN
- Practice address
- 12731 S Saginaw St
Grand Blanc, MI 48439-1830 - Phone
- (810) 695-6384
- Fax
- (810) 695-2944
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Jessie Warman
- Title
- Manager RX Licensing
- Phone
- (513) 762-1090
Corporate family (same tax ID) 24
Member of 1
Practitioners 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2076869 | The Kroger Co of Michigan | Certificate of waiver | Apr 28, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Co of Michigan |
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 MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041110000810 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 8820051816 | This NPI is an additional NPI on the enrollment |
| O20100930047114 | MI | DME Supplier - Pharmacy |
8820051816 | Practice locations: Grand Blanc, MI |
National Provider Directory
- Tax ID family
- Kroger Co of Michigan
Locations
12731 S Saginaw St
Grand Blanc, MI 48439
Phone (810) 695-6384
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 5301007124 | MI | Yes |
Addresses
Primary practice location
12731 S Saginaw St
Grand Blanc, MI 48439-1830
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4162016 | Medicaid | MI | |
| 2039385 | Other | PK |
Other names
- KROGER PHARMACY DBA KESSEL
Other providers in Grand Blanc, MI
- Erica Kovacs
- Sherry Lin Kowal
- Rhonda Lee Kozumplik
- Carole Cristine Kremer
- Madhavan Krishnamoorthy
- Mark Thomas Krupp II
- Renee M Krusniak
- KS Dental
- Adriana Kuhl
- Arvind R Kunadi
All providers in Grand Blanc, MI · Community/Retail Pharmacy in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 25, 2019. 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.