Organization Active NPI

Kroger Specialty Pharmacy FL 2 LLC

Specialty Pharmacy
Orlando, FL

National Provider Identifier

1508146010

Registry record updated Sep 30, 2020

On this page

Key facts
NPPES NPI Registry
National Provider Directory
NPI Registry JSON
Other providers in Orlando, FL
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Specialty PharmacyTaxonomy code 3336S0011X
License: PH25629 Issued in FL
Legal business name: KROGER SPECIALTY PHARMACY FL 2 LLC
Doing business as: KROGER SPECIALTY PHARMACY FL 2
Practice address: 6435 Hazeltine National Dr Ste 140
Orlando, FL 32822-5156
Phone: (855) 274-1694
Fax: (855) 819-6922
NPI assigned: Aug 29, 2011
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name: Debra J Cole
Title: Vice President
Phone: (855) 733-3126

Specialties & licenses 4

Specialty (taxonomy)	Code	License	State	Primary
Durable Medical Equipment & Medical Supplies	332B00000X
Pharmacy	333600000X
Community/Retail Pharmacy	3336C0003X
Specialty Pharmacy	3336S0011X	PH25629	FL	Primary

Addresses

Primary practice location

6435 Hazeltine National Dr Ste 140
Orlando, FL 32822-5156

Mailing address

6435 Hazeltine National Dr Ste 140
Orlando, FL 32822-5156
Phone (855) 274-1694

Other identifiers 47

Identifier	Type	State	Issuer
004264401	Medicaid	FL
0406939	Medicaid	MT
097296	Medicaid	AZ
1508146010	Medicaid	NV
201116160B	Other	KS	KANSAS (P) (CHILDREN WITH SPECIAL HEALTHCARE NEEDS)
2049652	Medicaid	VA
Q036221	Medicaid	TN
003131027B	Medicaid	GA
004264400	Medicaid	FL
0506711	Medicaid	NJ
1508146010	Medicaid	WI
1508146010	Medicaid	MI
16221397	Medicaid	NM
163522375	Medicaid	FL
500687694	Medicaid	OR
7100257570	Other	KY	KENTUCKY (P), PASSPORT HEALTH PLAN, WELLCARE OF KENTUCKY
100264920-00	Medicaid	NE
103011190-0001	Medicaid	PA
1508146010	Other	FL	FLORIDA CHILDREN'S MEDICAL SERVICES
1508146010	Medicaid	UT
18-20-CC-9559	Other	KY	KENTUCKY (CHILDREN WITH SPECIAL HEALTH CARE NEEDS)
200590550A	Other	OK	OKLAHOMA (P) CHILDREN WITH SPECIAL HEALTHCARE NEEDS PROGRAM VENDOR
201116160A	Other	KS	KANSAS (QMB)
64770109	Medicaid	CO
003131027A	Medicaid	GA
0212596	Medicaid	IA
1508146010	Medicaid	VA
1508146010	Medicaid	ID
Q036221	Other	ID	IDAHO (P) (CHILDREN WITH SPECIAL HEALTHCARE NEEDS)
0406827	Medicaid	MT
1508146010	Other	IN	INDIANA CHILDREN'S SPECIAL HEALTH CARE SERVICES PROGRAM
1508146010	Medicaid	MO
2131644	Other		PK
3102337	Medicaid	NH
3106044	Medicaid	NH
150015500	Medicaid	MD
216017	Medicaid	AL
1025997	Medicaid	VT
201121900A	Medicaid	IN
27828701	Medicaid	NM
7F5629	Medicaid	SC
DM1542	Medicaid	SC
0518565	Medicaid	NJ
15-17-CC-9559	Other	KY	KENTUCKY (CHILDREN WITH SPECIAL HEALTH CARE NEEDS)
1508146010	Medicaid	NC
1508146010	Medicaid	MN
500686927	Medicaid	OR

Other names 1

KROGER SPECIALTY PHARMACY FL 2 Doing business as

National Provider Directory

Member of 1

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

The Kroger Co
- Community/Retail Pharmacy
- Woodstock, GA
- NPI 1720012560
Member Of
NPD member

NPI Registry JSON

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

{
    "created_epoch": "1314576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1508146010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6435 HAZELTINE NATIONAL DR STE 140",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328225156",
            "telephone_number": "855-274-1694",
            "fax_number": "855-819-6922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6435 HAZELTINE NATIONAL DR STE 140",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328225156",
            "telephone_number": "855-274-1694",
            "fax_number": "855-819-6922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER SPECIALTY PHARMACY FL 2 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-29",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "855-733-3126"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
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            "license": null,
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            "state": "NJ"
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            "state": "WI"
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            "state": "MI"
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        {
            "code": "01",
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            "issuer": "KENTUCKY (P), PASSPORT HEALTH PLAN, WELLCARE OF KENTUCKY",
            "identifier": "7100257570",
            "state": "KY"
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        {
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            "desc": "MEDICAID",
            "issuer": null,
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        {
            "code": "01",
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        },
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        {
            "code": "05",
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            "issuer": null,
            "identifier": "1508146010",
            "state": "VA"
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        {
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            "desc": "MEDICAID",
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        {
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            "identifier": "1025997",
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            "identifier": "500686927",
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    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER SPECIALTY PHARMACY FL 2",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.