KROGER PHARMACY
NPI 1093749871
Pharmacy - Community/Retail Pharmacy in Vicksburg, MS
About Kroger Pharmacy NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KROGER PHARMACY (NPI 1093749871) is a healthcare organization registered as a community/retail pharmacy in Vicksburg, Mississippi and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through October 19, 2026 and lists Matt Mineer, Interface Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
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.
Other Names 1
Other Identifiers 4
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 25D1090849
Kroger Pharmacy #466 · Vicksburg, MSFrequently 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 1093749871. 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 Limited Partnership I located?
Kroger Limited Partnership I is located at 3405 Pemberton Square Blvd, Vicksburg, MS 39180. The listed phone number is (601) 638-3412.
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 hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 25D1090849) is associated with this NPI, valid through October 19, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Kroger Limited Partnership I was last updated on June 24, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.
