Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Pigeon Forge, TN
NPI 1790719425 · NPPES record last updated Apr 6, 2023
Key facts
- NPI
- 1790719425
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 3067 (TN)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 220 Wears Valley Rd
Pigeon Forge, TN 37863-4215 - Phone
- (865) 428-0629
- Fax
- (865) 908-5068
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Lysette Seilhamer
- Title
- Pharmacy Licensing Manager
- Phone
- (515) 762-1090
Other NPIs on the same Medicare enrollment 21
Corporate family (same tax ID) 24
Member of 1
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2081543 | Kroger Pharmacy #536 | Certificate of waiver | Jul 27, 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 TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140505001907 | TN | DME Supplier - Pharmacy |
8224930136 | Practice locations: Pigeon Forge, TN |
| O20140523001287 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 |
21 other NPIs on this enrollment Practice locations: Alcoa, TN; Seymour, TN; Sevierville, TN; Pigeon Forge, TN; Oak Ridge, TN; Nashville, TN; Memphis, TN; Maryville, TN… |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Locations
220 Wears Valley Rd
Pigeon Forge, TN 37863
Phone (865) 428-0629
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 3067 | TN | Yes |
Addresses
Primary practice location
220 Wears Valley Rd
Pigeon Forge, TN 37863-4215
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2091959 | Other | PK |
Other names
- KROGER PHARMACY
Other providers in Pigeon Forge, TN
- HQM of Pigeon Forge, LLC
- Daniel Israel
- K -VA -T Food Stores Inc
- Keith E. Whaley O.D.
- Rita K. King
- Wanda A. Lancaster
- Lee Liguore
- Travis Loveday
- LP Pigeon Forge LLC
- Marvin T Manning
All providers in Pigeon Forge, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2023. 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.