KROGER PHARMACY #401
NPI 1063896991
Pharmacy - Community/Retail Pharmacy in Roanoke, VA

Q: What is Kroger Limited Partnership I's NPI number?

The NPI number for Kroger Limited Partnership I is 1063896991. It was assigned to this organization in the NPPES registry on July 9, 2015. The provider is doing business as Kroger Pharmacy #401.

Q: 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.

Active since July 09, 2015CLIA 49D2106519 · Waiver

4375 BRAMBLETON AVE, ROANOKE, VA 24018(540) 772-0605(540) 772-0601 Get Directions Write a Review

NPPES record last updated: July 28, 2016. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: May 19, 2016, Dec 3, 2015 (2 updates tracked since 2015).

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About Kroger Pharmacy #401 NPPES

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

KROGER PHARMACY #401 (NPI 1063896991) is a healthcare organization registered as a community/retail pharmacy in Roanoke, Virginia and active in the NPI registry since July 2015. The organization holds a CLIA Waiver certificate valid through December 20, 2027 and lists Allison Muennich, Manager Of Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1063896991

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameKROGER LIMITED PARTNERSHIP I

Location Address4375 BRAMBLETON AVERoanoke, VA 24018-3404

Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092

Phone(540) 772-0605

Fax(540) 772-0601

Organization SubpartNo

Authorized OfficialAllison MuennichManager Of Pharmacy Licensing · (513) 762-1019

Enumeration DateJuly 9, 2015

Last NPPES UpdateJuly 28, 20162 updates tracked since enumeration

✔ NPI 1063896991 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in VA · 0201003350

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

4375 BRAMBLETON AVE, Roanoke, VA 24018

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Other Names 1

Doing Business AsKroger Pharmacy #401

Other Identifiers 4

Other2153031Pk

Medicaid1063896991VA

Medicare NSC1193770762

Medicare PINQ501910001

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 Arkansas Health & Wellness 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 49D2106519

Kroger Pharmacy#401 · Roanoke, VA

Active · expires Dec 20, 2027

CLIA Number49D2106519

Laboratory TypePharmacy

Certificate Effective DateDecember 21, 2025

Certificate Expiration DateDecember 20, 2027

Laboratory DirectorChris Koon

Laboratory Phone(540) 772-0605

Laboratory LocationKroger Pharmacy#4014375 Brambleton Avenue, Roanoke, VA 24018

CLIA data matches this NPI record on: Address Name Phone

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

Areas of Expertise CMS Part B claims 4

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.

290 services287 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.

284 services284 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

13 services13 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

13 services13 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy #401 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy #401

DMEPOS supplier · Roanoke, VAOperated by Kroger Limited Partnership I

✔

Accepts Medicare assignment

Kroger Pharmacy #401 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)20596853

Medicare Participant SinceAugust 27, 2003

Supplier Location4375 Brambleton AveRoanoke, VA 24018

Phone(540) 772-0605

Supplier Specialties

Pharmacy

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.

MISS AMANDA WILKERSON

Pharmacist

4375 BRAMBLETON AVE
ROANOKE, VA 24018

Roanoke County (540) 772-0601

JEBS INC

Pharmacy (Community/Retail Pharmacy)

4375 BRAMBLETON AVE
ROANOKE, VA 24018

Roanoke County (540) 772-0605

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 1063896991. It was assigned to this organization in the NPPES registry on July 9, 2015. The provider is doing business as Kroger Pharmacy #401.

Where is Kroger Limited Partnership I located?

Kroger Limited Partnership I is located at 4375 Brambleton Ave, Roanoke, VA 24018. The listed phone number is (540) 772-0605.

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 #401 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 49D2106519) is associated with this NPI, valid through December 20, 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 Arkansas Health & Wellness and Ambetter from Buckeye Health Plan and 39 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 July 28, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.