KROGER - NPI 1043691009 - Pharmacy in Knoxville, TN

Q: What is the provider's specialty?

The provider's specialty is Pharmacy with taxonomy code 333600000X.

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About Kroger NPPES

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

KROGER (NPI 1043691009) is a healthcare organization registered as a pharmacy in Knoxville, Tennessee and active in the NPI registry since June 2015. The organization holds a CLIA Waiver certificate valid through July 27, 2026 and lists Karla Langworthy, Manager Of Pharmacy Credentialing, as its authorized official.

NPPES Registry Identity

NPI1043691009

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameKROGER

Location Address2217 N BROADWAY STKnoxville, TN 37917-4719

Mailing Address2217 N Broadway StKnoxville, TN 37917-4719

Phone(865) 525-4629

Organization SubpartNo

Authorized OfficialKarla LangworthyManager Of Pharmacy Credentialing · (513) 698-1878

Enumeration DateJune 16, 2015

✔ NPI 1043691009 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in TN · 39228

Definition

A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

2217 N BROADWAY ST, Knoxville, TN 37917

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CLIA Laboratory Certificates CMS CLIA 2

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 44D2081516

Kroger Pharmacy #506 · Knoxville, TN

Active · expires Jul 27, 2026

CLIA Number44D2081516

Laboratory TypeRetail Pharmacy

Certificate Effective DateJuly 28, 2024

Certificate Expiration DateJuly 27, 2026

Laboratory DirectorDr. Marc Watkins

Laboratory Phone(865) 524-4629

Laboratory LocationKroger Pharmacy #5062217 Broadway, Knoxville, TN 37917

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 25D1021484

Kroger Pharmacy #492 · Madison, MS

Expired · Jan 22, 2026

CLIA Number25D1021484

Laboratory TypePharmacy

Certificate Effective DateJanuary 23, 2024

Certificate Expiration DateJanuary 22, 2026

Laboratory DirectorCynthia B. Fisher

Laboratory Phone(513) 698-1878

Laboratory LocationKroger Pharmacy #4921070 Hwy 51, Madison, MS 39110

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 7

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

DR. JAMES PERDIE RAINES JR. D.PH.

Pharmacist