Active NPI
Kroger Texas L P
Doing business as Kroger Pharmacy
- Community/Retail Pharmacy
- Rosenberg, TX
National Provider Identifier
1821221086
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 26445
- Legal business name
- KROGER TEXAS L P
- Doing business as
- Kroger Pharmacy
- Practice address
- 24401 Brazos Town Xing
Rosenberg, TX 77471-6268 - Phone
- (281) 232-1237
- Fax
- (281) 232-1239
- NPI assigned
- Sep 3, 2009
- Last updated
- Jun 27, 2016
- 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
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Community/Retail Pharmacy | 3336C0003X | 26445 | TX | Primary |
Addresses
Primary practice location
24401 Brazos Town Xing
Rosenberg, TX 77471-6268
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 466644 | Medicaid | TX | |
| 2121741 | Other | PK |
Other names 1
- Kroger Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20041103001304 | TX | Part B Supplier - Mass Immunization (Roster Biller Only) | 9638131303 | This NPI is an additional NPI on the enrollment |
| O20100930005576 | TX | DME Supplier - Pharmacy | 9638131303 | Practice locations: Rosenberg, TX |
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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 45D2001008 | Kroger Pharmacy 010 | Certificate of waiver | Dec 9, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #010 | 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 Texas
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.
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Kroger Pharmacy
- Community/Retail Pharmacy
- Pickerington, OH
- NPI 1245255967
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251936000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1466985600000",
"number": "1821221086",
"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": "24401 BRAZOS TOWN XING",
"city": "ROSENBERG",
"state": "TX",
"postal_code": "774716268",
"telephone_number": "281-232-1237",
"fax_number": "281-232-1239"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER TEXAS L P",
"organizational_subpart": "NO",
"enumeration_date": "2009-09-03",
"last_updated": "2016-06-27",
"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": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "TX",
"license": "26445",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "466644",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2121741",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kroger Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rosenberg, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2016; 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.