Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Chillicothe, IL
NPI 1780757302 · NPPES record last updated May 18, 2016
Key facts
- NPI
- 1780757302
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 054015070 (IL)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 603 S 4TH St
Chillicothe, IL 61523-2267 - Phone
- (309) 274-3419
- Fax
- (309) 274-2506
- NPI assigned
- Nov 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Other NPIs on the same Medicare enrollment 28
Corporate family (same tax ID) 15
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D1078906 | Kroger Pharmacy 677 | Certificate of waiver | Jan 16, 2028 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Limited Partnership I |
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 IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081104000404 | IL | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 |
33 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Streator, IL; Anna, IL; Washington, IL; Peoria, IL; Pekin, IL; Ottawa, IL; Normal, IL; Murphysboro, IL… |
| O20100930061205 | IL | DME Supplier - Pharmacy |
8224930136 | Practice locations: Chillicothe, IL |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Locations
603 S 4th St
Chillicothe, IL 61523
Phone (309) 274-3419
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 054015070 | IL | Yes |
Addresses
Primary practice location
603 S 4TH St
Chillicothe, IL 61523-2267
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2021479 | Other | PK |
Other names
- KROGER PHARMACY
Other providers in Chillicothe, IL
- Iowa Physicians Clinic Medical Foundation
- Jane Margaret Johnson
- Rebecca L Johnson
- Brenda Jean Jones
- Casey M Kimler
- Timothy J Lawless
- Mannerings Family Pharmacy
- Timothy A Mathis
- Deanna Mae McNaught
- Rachel Meier
All providers in Chillicothe, IL · Community/Retail Pharmacy in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 18, 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.