NPIMap

Organization Active NPI

Kroger Texas L P

Doing business as Kroger Pharmacy #179

  • Community/Retail Pharmacy
  • Cypress, TX
National Provider Identifier
1861872665
Registry record updated Sep 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
30092 Issued in TX
Legal business name
KROGER TEXAS L P
Doing business as
Kroger Pharmacy #179
Practice address
20355 Cypresswood Dr
Cypress, TX 77433-6477
Phone
(713) 507-6276
Fax
(713) 422-8031
NPI assigned
Jun 5, 2015
Last updated
Sep 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Community/Retail Pharmacy 3336C0003X 30092 TX Primary

Addresses

Primary practice location

20355 Cypresswood Dr
Cypress, TX 77433-6477

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
2152426OtherPK
467212MedicaidTX

Other names 1

  • Kroger Pharmacy #179 Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20101201000187 TX Part B Supplier - Mass Immunization (Roster Biller Only) 9638131303 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Burleson, TX; Wylie, TX; Saginaw, TX; Little Elm, TX; Houston, TX; Fort Worth, TX; Cypress, TX
O20160311001755 TX DME Supplier - Pharmacy 9638131303 Practice locations: Cypress, TX

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2137301Kroger Pharmacy #17920355 Cypresswood Dr, Cypress, TX 77433Certificate of waiverSep 24, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Pharmacy #17920355 Cypresswood Dr, Cypress, TX 77433-6477(713) 507-6276 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 assignmentParticipating since Dec 31, 1999

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.

Locations

20355 Cypresswood Dr
Cypress, TX 77433
Phone (832) 952-3180

NPI Registry JSON

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1475193600000",
    "number": "1861872665",
    "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": "20355 CYPRESSWOOD DR",
            "city": "CYPRESS",
            "state": "TX",
            "postal_code": "774336477",
            "telephone_number": "713-507-6276",
            "fax_number": "713-422-8031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER TEXAS L P",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-05",
        "last_updated": "2016-09-30",
        "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": "TX",
            "license": "30092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2152426",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "467212",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kroger Pharmacy #179",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cypress, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 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.

Verify at the official NPI Registry.