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KROGER CO OF MICHIGAN NPI 1750837670


NPI Information

NPI: 1750837670
Provider Name: KROGER CO OF MICHIGAN

Doing Business As: KROGER PHARMACY #743

Classification: Pharmacy - 3336C0003X
Entity Type: Organization

Specialization: Community/Retail Pharmacy

CLIA Number: 23D2128396

Address:
2200 E 12 MILE RD
ROYAL OAK, MI
ZIP 48067
Phone: (248) 397-1530
Get Directions

KROGER CO OF MICHIGAN is a community/retail pharmacy pharmacy in Royal Oak, MI. 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. KROGER CO OF MICHIGAN NPI is 1750837670. The provider is registered as an organization entity type.
The provider Is Doing Business As Kroger Pharmacy #743.

The provider's business location address is:

2200 E 12 MILE RD
ROYAL OAK, MI
ZIP 48067-504
Phone: (248) 397-1530
Fax: (248) 397-1532

The provider's authorized official is Allison Bredestege .
The authorized official title is Manager Of Pharmacy Licensing and has the following contact phone number (513) 762-1263.

The CLIA number assigned to this NPI record is 23D2128396 - pharmacy with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/31/2016 and was last updated on 1/17/2017.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1332B00000XDurable Medical Equipment & Medical SuppliesNo
2333600000XPharmacyNo
33336C0003XPharmacyCommunity/Retail Pharmacy5301011042MICHIGANYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11750837670MEDICAIDMICHIGAN
22163907OTHERPK
32663030110MEDICARE NSC
40P02440MEDICARE PIN

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: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.