NPIMap

Kroger Limited Partnership I

Organization Active NPI Community/Retail Pharmacy · Little Rock, AR

NPI 1962436717 · NPPES record last updated Sep 15, 2016

Key facts

NPI
1962436717
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
License
420105 (AR)
Legal business name
KROGER LIMITED PARTNERSHIP I
Practice address
8415 W Markham St
Little Rock, AR 72205-2405
Phone
(501) 227-8200
Fax
(501) 227-8201
NPI assigned
Jul 10, 2006
Organization subpart
No

Authorized official

Name
Allison Muennich
Title
Manager of Pharmacy Licensing
Phone
(513) 762-1019

Other NPIs on the same Medicare enrollment 27

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

View all 27

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Practitioners 3

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

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
04D1021896Kroger Pharmacy #630
8415 West Markham, Little Rock, AR 72205		Certificate of waiverFeb 2, 2028

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Kroger Pharmacy 630
8415 W Markham St, Little Rock, AR 72205-2405 · (501) 227-8200		 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 assignment
Participating since Aug 27, 2003

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in AR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930043969 AR DME Supplier - Pharmacy
DME Supplier - Grocery Store		 8224930136 Practice locations: Little Rock, AR
O20120807000530 AR Part B Supplier - Mass Immunization (Roster Biller Only) 8224930136 28 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Little Rock, AR; Maumelle, AR; N Little Rock, AR; North Little Rock, AR; Russellville, AR; West Memphis, AR; Conway, AR; Blythville, AR…

National Provider Directory

Tax ID family
Krogerthe Kroger Pharmac (611 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X 420105 AR Yes

Addresses

Primary practice location

8415 W Markham St
Little Rock, AR 72205-2405

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
140044407MedicaidAR
1988186OtherPK

Other names

  • KROGER PHARMACY Doing business as

Other providers in Little Rock, AR

All providers in Little Rock, AR · Community/Retail Pharmacy in Arkansas

Sources for this page

Verify at the official NPI Registry.