Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Decherd, TN
NPI 1851325583 · NPPES record last updated May 16, 2016
Key facts
- NPI
- 1851325583
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 1475 (TN)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 1840 Decherd Blvd
Decherd, TN 37324-3655 - Phone
- (931) 967-1218
- Fax
- (931) 968-9479
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Allison Muennich
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1019
Corporate family (same tax ID) 24
Member of 1
Practitioners 4
-
Timothy L Allish, PHARMD
-
Kevin Max Brooksbank, PHARMD
-
Tiffany Nicole Wiley-Cox, PHARM D
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D1078012 | Kroger Pharmacy L-503 | Certificate of waiver | Dec 25, 2027 |
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 |
|---|---|---|---|---|
| O20080114000140 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 | This NPI is an additional NPI on the enrollment |
| O20100930049455 | TN | DME Supplier - Pharmacy |
8224930136 | Practice locations: Decherd, TN |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Locations
1840 Decherd Blvd
Decherd, TN 37324
Phone (931) 967-1218
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 1475 | TN | Yes |
Addresses
Primary practice location
1840 Decherd Blvd
Decherd, TN 37324-3655
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2089465 | Other | PK |
Other names
- KROGER PHARMACY
Other providers in Decherd, TN
- Lisa Tassie Holder
- Misti D Howell
- J Lynn Williams MD
- Robert B Kilpatrick
- Leah Jayne Kowalewski
- William Andrew Kuhar Jr.
- Constance June Lynch
- Main St Medical Supply LLC
- Jason A. Martin
- James Thomas McClure
All providers in Decherd, 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 May 16, 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.
- 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.