Active NPI
The Kroger Co
Doing business as Kroger Pharmacy
- Community/Retail Pharmacy
- Newark, OH
National Provider Identifier
1659305449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 020164650
- Legal business name
- THE KROGER CO
- Doing business as
- Kroger Pharmacy
- Practice address
- 1155 N 21St St
Newark, OH 43055-3016 - Phone
- (740) 366-1186
- Fax
- (740) 258-6680
- NPI assigned
- Jul 10, 2006
- Last updated
- Apr 21, 2025
- Organization subpart
- No
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 020164650 | OH | Primary |
Addresses
Primary practice location
1155 N 21St St
Newark, OH 43055-3016
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2075643 | Other | PK | |
| 0415027 | Medicaid | OH | |
| 5401054100 | Medicaid | KY |
Other names 1
- KROGER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040928000446 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 6103738653 | This NPI is an additional NPI on the enrollment |
| O20100930051502 | OH | DME Supplier - Pharmacy | 6103738653 | Practice locations: Newark, OH |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D2020518 | Kroger Pharmacy #16-128 | Certificate of waiver | Feb 21, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| The Kroger Co | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Kroger Pharmacy 957
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.
-
dba Kroger Pharamcy #01600232
- Community/Retail Pharmacy
- Reynoldsburg, OH
- NPI 1548294341
-
dba Kroger Pharmacy #539
- Community/Retail Pharmacy
- Canal Winchester, OH
- NPI 1609790351
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": "1745193600000",
"number": "1659305449",
"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": "1155 N 21ST ST",
"city": "NEWARK",
"state": "OH",
"postal_code": "430553016",
"telephone_number": "740-366-1186",
"fax_number": "740-258-6680"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE KROGER CO",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-10",
"last_updated": "2025-04-21",
"certification_date": "2025-04-21",
"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": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "OH",
"license": "020164650",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2075643",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0415027",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5401054100",
"state": "KY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Newark, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; 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.