Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Little Rock, AR
NPI 1790719540 · NPPES record last updated Sep 15, 2016
Key facts
- NPI
- 1790719540
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 420086 (AR)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 6420 Colonel Glenn Rd
Little Rock, AR 72204-7724 - Phone
- (501) 565-0188
- Fax
- (501) 565-9616
- NPI assigned
- Jul 10, 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 27
Member of 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AR
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120807000530 | AR | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 |
28 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Little Rock, AR; Maumelle, AR; N Little Rock, AR; North Little Rock, AR; Russellville, AR; West Memphis, AR; Conway, AR; Blythville, AR… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 420086 | AR | Yes |
Addresses
Primary practice location
6420 Colonel Glenn Rd
Little Rock, AR 72204-7724
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 140031407 | Medicaid | AR | |
| 1993595 | Other | PK |
Other names
- KROGER PHARMACY
Other providers in Little Rock, AR
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Kroger Limited Partnership I
- Jennifer Krueger
- Katie Krueger
- Gregory Stanley Krulin
All providers in Little Rock, AR · Community/Retail Pharmacy in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.