Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

60006086A Issued in IN

Legal business name

KROGER LIMITED PARTNERSHIP I

Doing business as

Scotts Pharmacy J 404

Practice address

5300 Decatur Rd
Fort Wayne, IN 46806-3058

Phone

(260) 458-0840

Fax

(260) 458-9302

NPI assigned

Jun 20, 2007

Last updated

Jun 24, 2009By 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

Matt Mineer, CPHT

Title

Interface Manager

Phone

(513) 387-7074

Specialties & licenses 1

Addresses

Other names 1

• SCOTTS PHARMACY J 404 Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Locations

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

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SCOTTS PHARMACY J 404",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Scotts Pharmacy J 410)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy #425)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Scotts Pharmacy J424)
• Kroger Limited Partnership I (Scotts Pharmacy J412)
• Kroger Limited Partnership I (Scotts Pharmacy)

• Community/Retail Pharmacy in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• 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.