Active NPI
Kroger Co of Michigan
- Community/Retail Pharmacy
- Warren, MI
National Provider Identifier
1821022674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301007061
- Legal business name
- KROGER CO OF MICHIGAN
- Doing business as
- Kroger Co of Michigan
- Practice address
- 31200 Schoenherr Rd
Warren, MI 48088 - Phone
- (586) 238-4570
- NPI assigned
- Jul 10, 2006
- Last updated
- Oct 28, 2019
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jessie Warman
- Title
- Manager RX Licensing
- Phone
- (513) 762-1090
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 5301007061 | MI | Primary |
Addresses
Primary practice location
31200 Schoenherr Rd
Warren, MI 48088
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other practice location 1
13700 E 14 Mile Rd
Warren, MI 48088-1487
Phone (586) 285-9487
Other names 1
- KROGER CO OF MICHIGAN
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041110000810 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 8820051816 | This NPI is an additional NPI on the enrollment |
| O20100930021874 | MI | DME Supplier - Pharmacy | 8820051816 | Practice locations: Warren, MI |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy 18776 | 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 |
National Provider Directory
National Provider Directory- Tax ID family
- Kroger Co of Michigan
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.
-
- Community/Retail Pharmacy
- Flushing, MI
- NPI 1730113580
-
dba Kroger Pharmacy #743
- Community/Retail Pharmacy
- Royal Oak, MI
- NPI 1750837670
Locations
13700 E 14 Mile Rd
Warren, MI 48088
Phone (586) 285-9487
31200 Schoenherr Rd
Warren, MI 48088
Phone (586) 238-4570
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Pharmacist
- Dearborn, MI
- NPI 1205136116
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1572220800000",
"number": "1821022674",
"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": "31200 SCHOENHERR RD",
"city": "WARREN",
"state": "MI",
"postal_code": "48088",
"telephone_number": "586-238-4570"
}
],
"practiceLocations": [
{
"address_1": "13700 E 14 Mile Rd",
"address_purpose": "LOCATION",
"city": "Warren",
"state": "MI",
"postal_code": "480881487",
"country_code": "US",
"telephone_number": "586-285-9487",
"fax_number": "810-285-9504",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "KROGER CO OF MICHIGAN",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-10",
"last_updated": "2019-10-28",
"status": "A",
"authorized_official_last_name": "WARMAN",
"authorized_official_first_name": "JESSIE",
"authorized_official_title_or_position": "MANAGER RX LICENSING",
"authorized_official_telephone_number": "513-762-1090"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301007061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER CO OF MICHIGAN",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Warren, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.