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KROGER PHARMACY #499
NPI 1013297548
Pharmacy - Community/Retail Pharmacy in Horn Lake, MS

Active since August 29, 2011CLIA 25D2029470 · Waiver
3926 GOODMAN RD W, HORN LAKE, MS 38637(662) 393-7868(662) 393-1076 Get Directions Write a Review

NPPES record last updated: March 23, 2017. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Mar 23, 2017, May 16, 2016 (2 updates tracked since 2016).

About Kroger Pharmacy #499 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KROGER PHARMACY #499 (NPI 1013297548) is a healthcare organization registered as a community/retail pharmacy in Horn Lake, Mississippi and active in the NPI registry since August 2011. The organization holds a CLIA Waiver certificate valid through September 7, 2027 and lists Allison Muennich, Manager Of Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1013297548
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER LIMITED PARTNERSHIP I
Location Address3926 GOODMAN RD WHorn Lake, MS 38637-1324
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(662) 393-7868
Fax(662) 393-1076
Organization SubpartNo
Authorized OfficialAllison MuennichManager Of Pharmacy Licensing · (513) 762-1019
Enumeration DateAugust 29, 2011
Last NPPES UpdateMarch 23, 20172 updates tracked since enumeration
✔ NPI 1013297548 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in MS · 05036
Definition

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.

Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacyTaxonomy 333600000X
3926 GOODMAN RD W, Horn Lake, MS 38637
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Other Names 1

Doing Business AsKroger Pharmacy #499

Other Identifiers 5

Medicaid07451752MS
Other2131578Pk
Medicare NSC1193770713
Medicare PINP01394450
Medicare PIN302G735043

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2029470

Kroger Pharmacy #499 · Horn Lake, MS
Active · expires Sep 7, 2027
CLIA Number25D2029470
Laboratory TypePharmacy
Certificate Effective DateSeptember 8, 2025
Certificate Expiration DateSeptember 7, 2027
Laboratory DirectorCynthia B. Fisher
Laboratory Phone(901) 754-5124
Laboratory LocationKroger Pharmacy #4993926 Goodman Road, Horn Lake, MS 38637
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
54 services54 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
52 services52 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy #499 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy #499

DMEPOS supplier · Horn Lake, MSOperated by Kroger Limited Partnership I
✔

Accepts Medicare assignment

Kroger Pharmacy #499 agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20596001
Medicare Participant SinceAugust 27, 2003
Supplier Location3926 Goodman RdHorn Lake, MS 38663
Phone(662) 393-7868
Supplier Specialties
Pharmacy Grocery Store

Medicare Product Categories

Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Commodes, Urinals, Bedpans
Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
Blood Glucose Monitors/Supplies (Non-Mail Order)
Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ETHAN STOBAUGH
Pharmacist
3926 GOODMAN RD W
HORN LAKE, MS 38637
Desoto County (662) 393-7868
KELLY TODD WALDRIP
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
3926 GOODMAN RD W
HORN LAKE, MS 38637
Desoto County (662) 393-7868

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kroger Limited Partnership I's NPI number?

The NPI number for Kroger Limited Partnership I is 1013297548. It was assigned to this organization in the NPPES registry on August 29, 2011.

Where is Kroger Limited Partnership I located?

Kroger Limited Partnership I is located at 3926 Goodman Rd W, Horn Lake, MS 38637. The listed phone number is (662) 393-7868.

What is Kroger Limited Partnership I's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Kroger Limited Partnership I accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Kroger Pharmacy #499 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Kroger Limited Partnership I hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2029470) is associated with this NPI, valid through September 7, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kroger Limited Partnership I accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter from Absolute Total Care, Ambetter from Arizona Complete Health and Ambetter from Arkansas Health & Wellness and 46 other insurers list Kroger Limited Partnership I as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kroger Limited Partnership I was last updated on March 23, 2017. NPI Profile syncs with the weekly NPPES data releases published by CMS.