Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Indianapolis, IN
NPI 1710050232 · NPPES record last updated May 16, 2016
Key facts
- NPI
- 1710050232
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 60005545 (IN)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 1330 W Southport Rd
Indianapolis, IN 46217-5301 - Phone
- (317) 884-4250
- Fax
- (317) 884-4252
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D1076921 | Kroger Pharmacy J993 | Certificate of waiver | Nov 27, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #993 |
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080527000505 | IN | Part B Supplier - Pharmacy | 8224930136 | This NPI is an additional NPI on the enrollment |
| O20100930009982 | IN | DME Supplier - Pharmacy |
8224930136 | Practice locations: Indianapolis, IN |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 60005545 | IN | Yes |
Addresses
Primary practice location
1330 W Southport Rd
Indianapolis, IN 46217-5301
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2024339 | Other | PK | |
| 200283580A | Medicaid | IN |
Other names
- KROGER PHARMACY
Other providers in Indianapolis, IN
- 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 Indianapolis, IN · Community/Retail Pharmacy in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.