NPIMap

Organization Active NPI

Kroger Limited Partnership I

Doing business as Kroger Pharmacy L-794

  • Community/Retail Pharmacy
  • La Grange, KY
National Provider Identifier
1548949183
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
KROGER LIMITED PARTNERSHIP I
Doing business as
Kroger Pharmacy L-794
Practice address
2835 S Highway 393
La Grange, KY 40031-9613
Phone
(502) 530-4808
Fax
(502) 530-5828
NPI assigned
Jul 12, 2023
Last updated
May 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Authorized official

Name
Lysette Seilhamer
Title
Manager of Licensing
Phone
(515) 762-1090

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

2835 S Highway 393
La Grange, KY 40031-9613

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1090

Other names 1

  • Kroger Pharmacy L-794 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050422000416 KY Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 This NPI is an additional NPI on the enrollment
O20240424001292 KY DME Supplier - Pharmacy 8224930136 Practice locations: La Grange, KY

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
18D2287984Kroger Pharmacy #024-7942835 S Highway 393, La Grange, KY 40031Certificate of waiverAug 20, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Limited Partnership I2835 S Highway 393, La Grange, KY 40031-9613(502) 530-4808 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
Kroger Pharmacy611 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.

NPI Registry JSON

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

{
    "created_epoch": "1689120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716249600000",
    "number": "1548949183",
    "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": "513-762-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 S HIGHWAY 393",
            "city": "LA GRANGE",
            "state": "KY",
            "postal_code": "400319613",
            "telephone_number": "502-530-4808",
            "fax_number": "502-530-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-12",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A",
        "authorized_official_last_name": "SEILHAMER",
        "authorized_official_first_name": "LYSETTE",
        "authorized_official_title_or_position": "MANAGER OF LICENSING",
        "authorized_official_telephone_number": "515-762-1090"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kroger Pharmacy L-794",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kroger Pharmacy L-794",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in La Grange, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2024; 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.