Active NPI
The Kroger Co
- Community/Retail Pharmacy
- Brookhaven, GA
National Provider Identifier
1770517682
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 8318
- Legal business name
- THE KROGER CO
- Practice address
- 3871 Peachtree Rd NE
Brookhaven, GA 30319-3300 - Phone
- (404) 240-2812
- Fax
- (404) 240-2814
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 8318 | GA | Primary |
Addresses
Primary practice location
3871 Peachtree Rd NE
Brookhaven, GA 30319-3300
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2020210 | Other | PK | |
| 00824634A | Medicaid | GA |
Other names 1
- KROGER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 2
| 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 |
| O20100930029387 | GA | DME Supplier - Pharmacy | 6103738653 | Practice locations: Brookhaven, GA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D2098475 | Kroger Pharmacy #491 | Certificate of waiver | Jul 7, 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Kroger Sav on J926
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Community/Retail Pharmacy
- Warner Robins, GA
- NPI 1699709410
-
- Community/Retail Pharmacy
- Canton, GA
- NPI 1700810512
-
- Community/Retail Pharmacy
- Newnan, GA
- NPI 1710040225
-
- Community/Retail Pharmacy
- Grovetown, GA
- NPI 1710335443
-
- Community/Retail Pharmacy
- Woodstock, GA
- NPI 1720012560
-
- Community/Retail Pharmacy
- Duluth, GA
- NPI 1720012610
-
- Community/Retail Pharmacy
- Cumming, GA
- NPI 1730104514
-
- Community/Retail Pharmacy
- Athens, GA
- NPI 1730113549
-
- Community/Retail Pharmacy
- Cartersville, GA
- NPI 1730634239
-
- Community/Retail Pharmacy
- Dalton, GA
- NPI 1740214550
-
- Community/Retail Pharmacy
- Savannah, GA
- NPI 1740214584
-
- Community/Retail Pharmacy
- Dalton, GA
- NPI 1770517591
Locations
3871 Peachtree Rd NE
Brookhaven, GA 30319
Phone (404) 240-2812
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Brookhaven, GA
- NPI 1598399131
-
- Pharmacist
- Roswell, GA
- NPI 1144915018
-
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Brookhaven, GA
- NPI 1356688295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1745193600000",
"number": "1770517682",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 842772",
"city": "BOSTON",
"state": "MA",
"postal_code": "022842772",
"telephone_number": "513-762-1019",
"fax_number": "513-762-1092"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3871 PEACHTREE RD NE",
"city": "BROOKHAVEN",
"state": "GA",
"postal_code": "303193300",
"telephone_number": "404-240-2812",
"fax_number": "404-240-2814"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THE KROGER CO",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-10",
"last_updated": "2025-04-21",
"certification_date": "2025-04-21",
"status": "A",
"authorized_official_last_name": "MUENNICH",
"authorized_official_first_name": "ALLISON",
"authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
"authorized_official_telephone_number": "513-762-1019"
},
"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": "GA",
"license": "8318",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2020210",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00824634A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Brookhaven, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.