Kroger Texas L P

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

20215 Issued in TX

Legal business name

KROGER TEXAS L P

Doing business as

Kroger Pharmacy

Practice address

1420 E Highway 377
Granbury, TX 76048-2646

Phone

(817) 573-3745

Fax

(817) 573-7515

NPI assigned

Nov 15, 2006

Last updated

Apr 7, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Karla Langworthy

Title

Manager of Pharmacy Credentialing

Phone

(513) 698-1878

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Member of 1

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

• The Kroger Co

  dba Kroger Pharmacy

  • Community/Retail Pharmacy
  • Pickerington, OH
  • NPI 1245255967

  Member Of

  NPD member

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1396828800000",
    "number": "1659444263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19245 DAVID MEMORIAL DR",
            "city": "SHENANDOAH",
            "state": "TX",
            "postal_code": "773858778",
            "telephone_number": "713-507-6276",
            "fax_number": "936-442-6704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 E HIGHWAY 377",
            "city": "GRANBURY",
            "state": "TX",
            "postal_code": "760482646",
            "telephone_number": "817-573-3745",
            "fax_number": "817-573-7515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER TEXAS L P",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-15",
        "last_updated": "2014-04-07",
        "status": "A",
        "authorized_official_last_name": "LANGWORTHY",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY CREDENTIALING",
        "authorized_official_telephone_number": "513-698-1878"
    },
    "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": "TX",
            "license": "20215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2096801",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "464617",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brinleigh Kirkland
• Cynthia Malecki Knight, D.D.S.
• Christopher John Kochan, M.D.
• Kool C.a.T. Scooters USA LLC (Kool C.A.T. Scooters USA)
• Micaela Kramer, PT
• Kroger Texas LP (Kroger Pharmacy #917)
• Peter Kennedy Krone, MD
• Stephen George Krzeminski, D.O.
• Ailey Danielle Kubala
• David Larry Kuban, D.O.

• Community/Retail Pharmacy in Granbury, TX
• Providers in Granbury, TX by specialty
• Community/Retail Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; 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.