NPIMap

Organization Active NPI

Kroger Texas L P

  • Community/Retail Pharmacy
  • Fresno, TX
National Provider Identifier
1801048376
Registry record updated May 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
26082 Issued in TX
Legal business name
KROGER TEXAS L P
Practice address
10250 Fresno State Hwy 6
Fresno, TX 77545
Phone
(281) 431-6113
Fax
(281) 431-6117
NPI assigned
Oct 16, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2016

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X 26082 TX Primary

Addresses

Primary practice location

10250 Fresno State Hwy 6
Fresno, TX 77545

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
2117440OtherPK
466564MedicaidTX
466565MedicaidTX

Other names 1

  • Kroger Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041103001304 TX Part B Supplier - Mass Immunization (Roster Biller Only) 9638131303 This NPI is an additional NPI on the enrollment
O20100930055127 TX DME Supplier - Pharmacy 9638131303 Practice locations: Fresno, TX

National Provider Directory

National Provider Directory
Tax ID family
Kroger Texas201 organizations share this tax ID, including this one

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.

View all 24

Member of 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463529600000",
    "number": "1801048376",
    "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": "10250 FRESNO STATE HWY 6",
            "city": "FRESNO",
            "state": "TX",
            "postal_code": "77545",
            "telephone_number": "281-431-6113",
            "fax_number": "281-431-6117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER TEXAS L P",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-16",
        "last_updated": "2016-05-18",
        "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": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TX",
            "license": "26082",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2117440",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "466564",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "466565",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kroger Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fresno, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.