Active NPI
Kroger Limited Partnership I
- Community/Retail Pharmacy
- Portsmouth, VA
National Provider Identifier
1891729679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 0201003508
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 5601 High St W
Portsmouth, VA 23703-3758 - Phone
- (757) 686-8527
- Fax
- (757) 686-5260
- NPI assigned
- Jul 10, 2006
- 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
- Karla Langworthy
- Title
- Manager of Pharmacy Credentialing
- Phone
- (513) 698-1878
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 0201003508 | VA | Primary |
Addresses
Primary practice location
5601 High St W
Portsmouth, VA 23703-3758
Mailing address
3631 Peters Creek Rd NW
Roanoke, VA 24019-2809
Phone (540) 563-3593
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 008508470 | Medicaid | VA | |
| 2105038 | Other | PK |
Other names 1
- KROGER PHARMACY
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV, VA
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040721001195 | WV | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 |
This NPI is an additional NPI on the enrollment Practice locations: Logan, WV; Parkersburg, WV; Madison, WV; Marmet, WV; Morgantown, WV; Oak Hill, WV; Princeton, WV; Rainelle, WV… |
| O20050207000561 | VA | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider DirectoryMember 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": "1152489600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1396828800000",
"number": "1891729679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3631 PETERS CREEK RD NW",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240192809",
"telephone_number": "540-563-3593",
"fax_number": "540-563-1436"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 HIGH ST W",
"city": "PORTSMOUTH",
"state": "VA",
"postal_code": "237033758",
"telephone_number": "757-686-8527",
"fax_number": "757-686-5260"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KROGER LIMITED PARTNERSHIP I",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-10",
"last_updated": "2014-04-07",
"status": "A",
"authorized_official_last_name": "LANGWORTHY",
"authorized_official_first_name": "KARLA",
"authorized_official_title_or_position": "MANAGER OF PHARMACY CREDENTIALING",
"authorized_official_telephone_number": "513-698-1878"
},
"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": "VA",
"license": "0201003508",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "008508470",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2105038",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "KROGER PHARMACY",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Portsmouth, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.