The Kroger Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

MP0552282 Issued in WV

Legal business name

THE KROGER CO

Doing business as

Kroger Pharmacy

Practice address

3558 Main St
Weirton, WV 26062-4508

Phone

(304) 748-6290

Fax

(304) 648-6292

NPI assigned

Jul 13, 2006

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 Pharmacy Licensing

Phone

(513) 762-1090

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Weirton, WV
  • NPI 1174557961

  O20040929001241

  Same enrollment
• The Kroger Co

  dba Kroger Pharmacy N-562

  • Community/Retail Pharmacy
  • Wheeling, WV
  • NPI 1245264035

  O20040929001241

  Same enrollment
• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Wheeling, WV
  • NPI 1699790394

  O20040929001241

  Same enrollment
• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Wellsburg, WV
  • NPI 1760416556

  O20040929001241

  Same enrollment
• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Moundsville, WV
  • NPI 1851325641

  O20040929001241

  Same enrollment

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Carolyn M Anderson, RPH

  • Pharmacist
  • Weirton, WV
  • NPI 1962950071
  NPD (past)

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580774400000",
    "number": "1508881202",
    "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": "3558 MAIN ST",
            "city": "WEIRTON",
            "state": "WV",
            "postal_code": "260624508",
            "telephone_number": "304-748-6290",
            "fax_number": "304-648-6292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2020-02-04",
        "certification_date": "2020-02-04",
        "status": "A",
        "authorized_official_last_name": "WARMAN",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "MANAGER PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1090"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "WV",
            "license": "MP0552282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0015394000003",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2111422",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0013178042",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Community/Retail Pharmacy in Weirton, WV
• Providers in Weirton, WV by specialty
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2020; 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.