NPIMap

Organization Active NPI

Kroger Co

  • Community/Retail Pharmacy
  • Lake Charles, LA
National Provider Identifier
1932647179
Registry record updated Mar 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7474 Issued in LA
Legal business name
KROGER CO
Practice address
2010 Country Club Rd
Lake Charles, LA 70605-5206
Phone
(337) 990-4902
Fax
(337) 990-4904
NPI assigned
Feb 8, 2017
Last updated
Mar 15, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Allison Bredestege
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1263

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 7474 LA Primary

Addresses

Primary practice location

2010 Country Club Rd
Lake Charles, LA 70605-5206

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050126000748 LA Part B Supplier - Mass Immunization (Roster Biller Only) 6103738653 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Charles, LA; Shreveport, LA
O20170602000771 LA DME Supplier - Pharmacy 6103738653 Practice locations: Lake Charles, LA

Other NPIs on the same Medicare enrollment 1

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Pharmacy #3942010 Country Club Rd, Lake Charles, LA 70605-5206(337) 990-4902 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 Oct 18, 2023

National Provider Directory

National Provider Directory
Tax ID family
Kroger Pharmacy 957319 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1486512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1521072000000",
    "number": "1932647179",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 COUNTRY CLUB RD",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706055206",
            "telephone_number": "337-990-4902",
            "fax_number": "337-990-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-08",
        "last_updated": "2018-03-15",
        "status": "A",
        "authorized_official_last_name": "BREDESTEGE",
        "authorized_official_first_name": "ALLISON",
        "authorized_official_title_or_position": "MANAGER OF PHARMACY LICENSING",
        "authorized_official_telephone_number": "513-762-1263"
    },
    "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": "LA",
            "license": "7474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2018; 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.