Kroger Limited Partnership I

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

C3370 Issued in TN

Legal business name

KROGER LIMITED PARTNERSHIP I

Doing business as

KROGER PHARMACY

Practice address

112 Sunset Dr
Johnson City, TN 37604-2503

Phone

(423) 283-0522

Fax

(423) 283-0945

NPI assigned

Jul 10, 2006

Organization subpart

No

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 3

Addresses

Other identifiers 2

Other names 1

• KROGER PHARMACY Doing business as

Medicare fee-for-service enrollment

Enrolled in WV, TN3 enrollments

Enrollment records 3

These 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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• The Kroger Co

  • Community/Retail Pharmacy
  • Woodstock, GA
  • NPI 1720012560

  Member Of

  NPD member

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Haley Bullough, RPH

  • Pharmacist
  • Johnson City, TN
  • NPI 1568297224
  NPD (past)
• Kathryn Cifelli Durbin

  • Pharmacist
  • Johnson City, TN
  • NPI 1164381307
  NPD (past)
• Rhett M Miller, PHARMD

  • Pharmacist
  • Johnson City, TN
  • NPI 1053614180
  NPD (past)
• Wallace Lee Whitaker, D.PH.

  • Pharmacist
  • Johnson City, TN
  • NPI 1447583844
  NPD (past)

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1463356800000",
    "number": "1881628527",
    "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": "112 SUNSET DR",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376042503",
            "telephone_number": "423-283-0522",
            "fax_number": "423-283-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER LIMITED PARTNERSHIP I",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "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": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "TN",
            "license": "C3370",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455053",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2092726",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KROGER PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Daniel E. Krenk, MD
• David Edward Kreshek, M.D.
• Koyamangalath Krishnan, MD
• Karsyn Krob
• Kroger Limited Partnership I
• Daniel Robert Kubisiak, D.PH
• Kathleen Anne Kuczynski, DSW MSW
• Shelley J Kudialis, CRNA
• Susan Mahmoud Khaled Kullab, MD
• P Lucy Kumar, MD

• Community/Retail Pharmacy in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Community/Retail Pharmacy in Tennessee

• 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.

Verify at the official NPI Registry.