Active NPI
Kroger Co of Michigan
Doing business as Kroger Pharmacy #729
- Community/Retail Pharmacy
- Commerce Township, MI
National Provider Identifier
1861824583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5315062748
- Legal business name
- KROGER CO OF MICHIGAN
- Doing business as
- Kroger Pharmacy #729
- Practice address
- 2905 Union Lake Rd
Commerce Township, MI 48382-3565 - Phone
- (248) 779-6210
- Fax
- (248) 779-6212
- NPI assigned
- Aug 5, 2013
- 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 | |||
| Community/Retail Pharmacy | 3336C0003X | 5315062748 | MI | Primary |
Addresses
Primary practice location
2905 Union Lake Rd
Commerce Township, MI 48382-3565
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2141560 | Other | PK |
Other names 1
- Kroger Pharmacy #729
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 |
| O20140130001372 | MI | DME Supplier - Pharmacy | 8820051816 | Practice locations: Commerce Township, 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.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2066489 | Kroger Pharmacy #729 | Certificate of waiver | Sep 26, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Co of Michigan | 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
- Warren, MI
- NPI 1821022674
-
dba Kroger Pharmacy
- Community/Retail Pharmacy
- Clinton Township, MI
- NPI 1841224698
-
dba Kroger Pharmacy #759
- Community/Retail Pharmacy
- White Lake, MI
- NPI 1851325690
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": "1375660800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1463356800000",
"number": "1861824583",
"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": "2905 UNION LAKE RD",
"city": "COMMERCE TOWNSHIP",
"state": "MI",
"postal_code": "483823565",
"telephone_number": "248-779-6210",
"fax_number": "248-779-6212"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER CO OF MICHIGAN",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-05",
"last_updated": "2016-05-16",
"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": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5315062748",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2141560",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Kroger Pharmacy #729",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Commerce Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 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.