Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60006086A Issued in IN

Legal business name

KROGER LIMITED PARTNERSHIP I

Practice address

5300 Decatur Rd
Fort Wayne, IN 46806-3058

Phone

(260) 458-0840

Fax

(260) 458-9302

NPI assigned

Jun 20, 2007

Organization subpart

No

Name

Matt Mineer, CPHT

Title

Interface Manager

Phone

(513) 387-7074

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

• The Kroger Co

  • Community/Retail Pharmacy
  • Woodstock, GA
  • NPI 1720012560

  Member Of

  NPD member

Medicare fee-for-service enrollment

Enrolled in IN

• SCOTTS PHARMACY J 404 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 24, 2009.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245801600000",
    "number": "1659576395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5960 CASTLEWAY WEST DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462501977",
            "telephone_number": "317-579-8434",
            "fax_number": "317-579-8424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5300 DECATUR RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468063058",
            "telephone_number": "260-458-0840",
            "fax_number": "260-458-9302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-20",
        "last_updated": "2009-06-24",
        "status": "A",
        "authorized_official_last_name": "MINEER",
        "authorized_official_first_name": "MATT",
        "authorized_official_title_or_position": "INTERFACE MANAGER",
        "authorized_official_telephone_number": "513-387-7074",
        "authorized_official_credential": "CPHT"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IN",
            "license": "60006086A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "1561542",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200872420A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCOTTS PHARMACY J 404",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I
• Kroger Limited Partnership I

• All providers in Fort Wayne, IN
• Community/Retail Pharmacy in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; 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.