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THE KROGER CO NPI 1053345785


NPI Information

NPI: 1053345785
Provider Name: THE KROGER CO

Doing Business As: KROGER PHARMACY

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 42D1005272

Address:
3735 RENEE DR
MYRTLE BEACH, SC
ZIP 29579
Phone: (843) 236-4296
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THE KROGER CO is a community/retail pharmacy pharmacy in Myrtle Beach, SC. The provider is a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes. THE KROGER CO NPI is 1053345785. The provider is registered as an organization entity type.
The provider Is Doing Business As Kroger Pharmacy.

The provider's business location address is:

3735 RENEE DR
MYRTLE BEACH, SC
ZIP 29579-109
Phone: (843) 236-4296
Fax: (843) 236-4274

The provider's authorized official is Allison Muennich .
The authorized official title is Manager Of Pharmacy Licensing and has the following contact phone number (513) 762-1019.

The CLIA number assigned to this NPI record is 42D1005272 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/10/2006 and was last updated on 6/28/2016.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail Pharmacy5004984SOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
10302060809MEDICARE NSC
2Q352540001MEDICARE PIN
32091717OTHERPK
4P01395410MEDICARE PIN
5749842MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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