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KROGER PHARMACY
NPI 1093749863
Pharmacy - Community/Retail Pharmacy in Clarkston, MI

Active since July 10, 2006CLIA 23D2077007 · Waiver
9741 DIXIE HWY, CLARKSTON, MI 48348(248) 922-0468(248) 922-0838 Get Directions Write a Review

NPPES record last updated: January 25, 2019. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 25, 2019, May 16, 2016 (2 updates tracked since 2016).

About Kroger Pharmacy NPPES

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

KROGER PHARMACY (NPI 1093749863) is a healthcare organization registered as a community/retail pharmacy in Clarkston, Michigan and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through April 29, 2028 and lists Jessie Warman, Manager Rx Licensing, as its authorized official.

NPPES Registry Identity

NPI1093749863
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER CO OF MICHIGAN
Location Address9741 DIXIE HWYClarkston, MI 48348-4145
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(248) 922-0468
Fax(248) 922-0838
Organization SubpartNo
Authorized OfficialJessie WarmanManager Rx Licensing · (513) 762-1090
Enumeration DateJuly 10, 2006
Last NPPES UpdateJanuary 25, 20192 updates tracked since enumeration
✔ NPI 1093749863 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 MI · 5301007866
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
9741 DIXIE HWY, Clarkston, MI 48348
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Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 2

Other2046680Pk
Medicaid2365725MI

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 23D2077007

Kroger Co Of Michigan, The · Clarkston, MI
Active · expires Apr 29, 2028
CLIA Number23D2077007
Laboratory TypeRetail Pharmacy
Certificate Effective DateApril 30, 2026
Certificate Expiration DateApril 29, 2028
Laboratory DirectorRobert Brown
Laboratory Phone(248) 922-0468
Laboratory LocationKroger Co Of Michigan, The9741 Dixie Highway Kroger Pharmacy 018-709 Attn Pharmacist In Charge, Clarkston, MI 48348
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.
178 services176 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.
168 services166 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.
64 services64 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.
64 services64 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy 709 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy 709

DMEPOS supplier · Clarkston, MIOperated by Kroger Co Of Michigan
✔

Accepts Medicare assignment

Kroger Pharmacy 709 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)20410811
Medicare Participant SinceNovember 5, 2020
Supplier Location9741 Dixie HwyClarkston, MI 48348
Phone(248) 922-0468
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 3

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

SRINIVASA RAO BANDARUPALLI R.PH
Pharmacist
9741 DIXIE HWY
CLARKSTON, MI 48348
Oakland County (248) 922-0468
FREDERICK A MARSAC RPH
Pharmacist
9741 DIXIE HWY
CLARKSTON, MI 48348
Oakland County (248) 922-0652
AMY IANNARONE PHARM D
Pharmacist
9741 DIXIE HWY
CLARKSTON, MI 48348
Oakland County (248) 922-0468

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 Co Of Michigan's NPI number?

The NPI number for Kroger Co Of Michigan is 1093749863. It was assigned to this organization in the NPPES registry on July 10, 2006. The provider is doing business as Kroger Pharmacy.

Where is Kroger Co Of Michigan located?

Kroger Co Of Michigan is located at 9741 Dixie Hwy, Clarkston, MI 48348. The listed phone number is (248) 922-0468.

What is Kroger Co Of Michigan's specialty?

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

Does Kroger Co Of Michigan accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Kroger Pharmacy 709 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Kroger Co Of Michigan hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2077007) is associated with this NPI, valid through April 29, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kroger Co Of Michigan 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 47 other insurers list Kroger Co Of Michigan 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 Co Of Michigan was last updated on January 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.