NPIMap

Organization Active NPI

Kroger Limited Partnership I

  • Community/Retail Pharmacy
  • Blacksburg, VA
National Provider Identifier
1528092392
Registry record updated May 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
0201003605 Issued in VA
Legal business name
KROGER LIMITED PARTNERSHIP I
Practice address
903 University City Blvd
Blacksburg, VA 24060-2771
Phone
(540) 951-4136
Fax
(540) 951-4203
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 16, 2016

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

Authorized official

Name
Allison Muennich
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1019

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 0201003605 VA Primary

Addresses

Primary practice location

903 University City Blvd
Blacksburg, VA 24060-2771

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other identifiers 2

IdentifierTypeStateIssuer
008517681MedicaidVA
2104265OtherPK

Other names 1

  • KROGER PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, VA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040721001195 WV Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 This NPI is an additional NPI on the enrollment
Practice locations: Logan, WV; Parkersburg, WV; Madison, WV; Marmet, WV; Morgantown, WV; Oak Hill, WV; Princeton, WV; Rainelle, WV…
O20050207000561 VA Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 This NPI is an additional NPI on the enrollment
O20100930043021 VA DME Supplier - PharmacyDME Supplier - Grocery Store 8224930136 Practice locations: Blacksburg, VA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1078314Kroger Pharmacy #210903 University City Boulevard, Blacksburg, VA 24060Certificate of waiverJan 6, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Pharmacy 210903 University City Blvd, Blacksburg, VA 24060-2709(540) 951-4136 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 assignmentParticipating since Aug 27, 2003

National Provider Directory

National Provider Directory
Tax ID family
Krogerthe Kroger Pharmac611 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Member of 1

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

Locations

903 University City Blvd
Blacksburg, VA 24060
Phone (540) 951-4136

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1528092392",
    "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": "903 UNIVERSITY CITY BLVD",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240602771",
            "telephone_number": "540-951-4136",
            "fax_number": "540-951-4203"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2016-05-16",
        "status": "A",
        "authorized_official_last_name": "MUENNICH",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1019"
    },
    "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": "VA",
            "license": "0201003605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008517681",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2104265",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blacksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.