The Kroger Co

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

PHRE009719 Issued in GA

Legal business name

THE KROGER CO

Practice address

505 Dacula Rd
Dacula, GA 30019-2125

Phone

(678) 407-8739

Fax

(678) 407-8741

NPI assigned

Jan 10, 2011

Organization subpart

No

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) 762-1019

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

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

Tax ID family

Kroger Sav on J926319 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

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

• The Kroger Co

  • Community/Retail Pharmacy
  • Atlanta, GA
  • NPI 1922032754
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Marietta, GA
  • NPI 1932124617
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Warner Robins, GA
  • NPI 1932393550
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Marietta, GA
  • NPI 1942234778
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Martinez, GA
  • NPI 1942234794
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Lilburn, GA
  • NPI 1952335770
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Tucker, GA
  • NPI 1952335861
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Covington, GA
  • NPI 1952592990
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Stockbridge, GA
  • NPI 1972528651
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Jasper, GA
  • NPI 1972537785
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Hoschton, GA
  • NPI 1982497814
  NPD tax ID
• The Kroger Co

  • Community/Retail Pharmacy
  • Alpharetta, GA
  • NPI 1982629663
  NPD tax ID

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1513814400000",
    "number": "1982908687",
    "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": "505 DACULA RD",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300192125",
            "telephone_number": "678-407-8739",
            "fax_number": "678-407-8741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE KROGER CO",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-10",
        "last_updated": "2017-12-21",
        "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": "513-762-1019"
    },
    "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": "GA",
            "license": "PHRE009719",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003107006A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2128329",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community/Retail Pharmacy in Dacula, GA
• Providers in Dacula, GA by specialty
• Community/Retail Pharmacy in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2017; 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.