Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

552243 Issued in WV

Legal business name

KROGER LIMITED PARTNERSHIP I

Practice address

3032 E Cumberland Rd
Bluefield, WV 24701-4858

Phone

(304) 327-0823

Fax

(304) 327-0828

NPI assigned

Jul 10, 2006

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

Pharmacy Licensing Manager

Phone

(513) 698-1878

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Member of 1

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Kelli Bovenizer Louthan, PHARM D

  • Pharmacist
  • Bluefield, WV
  • NPI 1992009476
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335139200000",
    "number": "1699709485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3631 PETERS CREEK RD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240192809",
            "telephone_number": "540-563-3593",
            "fax_number": "540-563-1436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3032 E CUMBERLAND RD",
            "city": "BLUEFIELD",
            "state": "WV",
            "postal_code": "247014858",
            "telephone_number": "304-327-0823",
            "fax_number": "304-327-0828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2012-04-23",
        "status": "A",
        "authorized_official_last_name": "LANGWORTHY",
        "authorized_official_first_name": "KARLA",
        "authorized_official_title_or_position": "PHARMACY LICENSING MANAGER",
        "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": "WV",
            "license": "552243",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0013178037",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "5011440",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008517592",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tina Marie King
• Cassandra Kirkpatrick, MD
• Angel Lynne Knight
• Abed Koja, M.D.
• Radha K Krishnan, MD
• Paul R Kuraguntla, MD
• Laboratory Corporation of America Holdings
• Ethan Shamus Lafferty, DDS
• Ameneh Lambert, NP
• Latasha N Lambert

• All providers in Bluefield, WV
• Community/Retail Pharmacy in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2012; 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.