Kroger Limited Partnership I
Organization Active NPI Community/Retail Pharmacy · Oakland, TN
NPI 1952335697 · NPPES record last updated Mar 13, 2020
Key facts
- NPI
- 1952335697
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 3839 (TN)
- Legal business name
- KROGER LIMITED PARTNERSHIP I
- Practice address
- 7265 Highway 64
Oakland, TN 38060-3403 - Phone
- (901) 465-1605
- Fax
- (901) 465-3057
- NPI assigned
- Jul 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Jessie Warman
- Title
- Manager of Pharmacy Licensing
- Phone
- (513) 762-1090
Corporate family (same tax ID) 14
Member of 1
Practitioners 3
-
Dawn M Doughten, PHARMD
-
Ashley Brooke Jenkins, PHARMD
-
Jennifer Reynolds, DPH
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Kroger Pharmacy #462 |
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 and/or Supplies|Surgical Dressings | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080114000140 | TN | Part B Supplier - Mass Immunization (Roster Biller Only) | 8224930136 | This NPI is an additional NPI on the enrollment |
| O20100930098266 | TN | DME Supplier - Pharmacy |
8224930136 | Practice locations: Oakland, TN |
National Provider Directory
- Tax ID family
- Krogerthe Kroger Pharmac
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 3839 | TN | Yes |
Addresses
Primary practice location
7265 Highway 64
Oakland, TN 38060-3403
Mailing address
PO Box 842772
Boston, MA 02284-2772
Phone (513) 762-1019
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2093799 | Other | PK | |
| 4436223 | Medicaid | TN |
Other names
- KROGER PHARMACY
Other providers in Oakland, TN
- Valerie Javier
- Ashley Brooke Jenkins
- Ashley Wise Jett
- April M Joyner
- David Scott Krapf
- Lifesteps LLC
- Catherine Ann Lipsey
- Darrin Lyons
- MBC Inc
- Cha'Landria Arenette McCall
All providers in Oakland, TN · Community/Retail Pharmacy in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.