NPIMap

Kroger Limited Partnership I

Organization Active NPI Community/Retail Pharmacy · Memphis, TN

NPI 1780139154 · NPPES record last updated Mar 13, 2020

Key facts

NPI
1780139154
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
Legal business name
KROGER LIMITED PARTNERSHIP I
Practice address
1759 Union Ave
Memphis, TN 38104-6143
Phone
(901) 721-0805
Fax
(901) 721-0802
NPI assigned
Aug 16, 2016
Organization subpart
No

Authorized official

Name
Jessie Warman
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1090

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 6

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
44D2119764Kroger Pharmacy #402
1759 Union Ave, Memphis, TN 38104		Certificate of waiverOct 3, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Pharmacy #402
1759 Union Ave, Memphis, TN 38104-6143 · (901) 721-0805		 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
Participating since Aug 27, 2003

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TN

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20140523001287 TN Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Alcoa, TN; Seymour, TN; Sevierville, TN; Pigeon Forge, TN; Oak Ridge, TN; Nashville, TN; Memphis, TN; Maryville, TN…
O20161201002161 TN DME Supplier - Pharmacy 8224930136 Practice locations: Memphis, TN

National Provider Directory

Tax ID family
Krogerthe Kroger Pharmac (611 organizations share this tax ID)

Locations

1759 Union Ave
Memphis, TN 38104
Phone (901) 721-0805

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Yes

Addresses

Primary practice location

1759 Union Ave
Memphis, TN 38104-6143

Mailing address

PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019

Other identifiers

IdentifierTypeStateIssuer
2163908OtherPK

Other names

  • Kroger Pharmacy #402 Doing business as

Other providers in Memphis, TN

All providers in Memphis, TN · Community/Retail Pharmacy in Tennessee

Sources for this page

Verify at the official NPI Registry.