Kroger Limited Partnership I
Pharmacy, Community/Retail Pharmacy in Taylorville, IL. Organization (NPI-2).
Details
- NPI
- 1871666495
- Entity type
- Organization (NPI-2)
- Legal business name
- Kroger Limited Partnership I
- Organization subpart
- No
- Enumeration date
- Nov 15, 2006
- Last updated
- Dec 14, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | 054015081 | IL | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 333600000X | Pharmacy | – | – |
Other names
- Kroger Pharmacy J-888 (Doing Business As)
Practice location
201 E Bidwell StTaylorville, IL 62568-1361
Phone 217-287-7391 · Fax 217-287-7440
Mailing address
5960 Castleway West DrIndianapolis, IN 46250-1977
Phone 317-579-8434 · Fax 317-579-8424
Authorized official
Matt Mineer
Interface Manager
5133877074
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 5 Community/Retail Pharmacy providers in Taylorville · All 209 providers in Taylorville
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