The Kroger Co
Organization Active NPI Community/Retail Pharmacy · Dalton, GA
NPI 1740214550 · NPPES record last updated May 16, 2016
Key facts
- NPI
- 1740214550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 8314 (GA)
- Legal business name
- THE KROGER CO
- Practice address
- 1365 W Walnut Ave
Dalton, GA 30720-3857 - Phone
- (706) 270-0850
- Fax
- (706) 270-0852
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Practitioners 2
-
Tara Nicole Taylor Ayers, PHARMD
-
Chad Michael Rhodes, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2098260 | Kroger Pharmacy #458 | Certificate of waiver | Jul 1, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| The Kroger Co |
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 GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090227000285 | GA | Part B Supplier - Mass Immunization (Roster Biller Only) | 6103738653 | This NPI is an additional NPI on the enrollment |
| O20100930026229 | GA | DME Supplier - Pharmacy |
6103738653 | Practice locations: Dalton, GA |
National Provider Directory
- Tax ID family
- Kroger Sav on J926
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 8314 | GA | Yes |
Addresses
Primary practice location
1365 W Walnut Ave
Dalton, GA 30720-3857
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2020225 | Other | PK | |
| 00837471A | Medicaid | GA |
Other names
- KROGER PHARMACY
Other providers in Dalton, GA
- Erin W Thaggard
- Craig R Thayer
- The Deo Clinic, Inc
- The Healing Center, LLC
- The Hearing Group, LLC
- The Kroger Co
- The Meadows Edge, LLC
- The Perfect Fit Salon Inc
- The Stevens Psychology Clinic
- The Wellnest Company, LLC
All providers in Dalton, GA · Community/Retail Pharmacy in Georgia
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.