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KROGER PHARMACY #749
NPI 1154521060
Pharmacy - Community/Retail Pharmacy in St. Clair Shores, MI

Active since July 19, 2007CLIA 23D2077075 · Waiver
22801 HARPER AVE, ST. CLAIR SHORES, MI 48080(586) 800-5190(586) 800-5195 Get Directions Write a Review

NPPES record last updated: June 14, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 14, 2021, Jan 25, 2019, May 16, 2016 (3 updates tracked since 2016).

About Kroger Pharmacy #749 NPPES

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

KROGER PHARMACY #749 (NPI 1154521060) is a healthcare organization registered as a community/retail pharmacy in St. Clair Shores, Michigan and active in the NPI registry since July 2007. The organization holds a CLIA Waiver certificate valid through April 29, 2028 and lists Bill Shinton, Vice President Kroger Health, as its authorized official.

NPPES Registry Identity

NPI1154521060
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER CO OF MICHIGAN
Location Address22801 HARPER AVESt. Clair Shores, MI 48080
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(586) 800-5190
Fax(586) 800-5195
Organization SubpartNo
Authorized OfficialBill ShintonVice President Kroger Health · (513) 762-1090
Enumeration DateJuly 19, 2007
Last NPPES UpdateJune 14, 20213 updates tracked since enumeration
NPPES CertifiedJune 14, 2021
✔ NPI 1154521060 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 MI · 5301008647
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
22801 HARPER AVE, St. Clair Shores, MI 48080
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Other Names 1

Doing Business AsKroger Pharmacy #749

Other Identifiers 2

Medicaid2369975MI
Other2042697Pk

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 23D2077075

Kroger Co Of Michigan #018-749, The · Saint Clair Shores, MI
Active · expires Apr 29, 2028
CLIA Number23D2077075
Laboratory TypePharmacy
Certificate Effective DateApril 30, 2026
Certificate Expiration DateApril 29, 2028
Laboratory DirectorRobert Brown
Laboratory Phone(586) 800-5190
Laboratory LocationKroger Co Of Michigan #018-749, The22801 Harper Ave, Saint Clair Shores, MI 48080
CLIA data matches this NPI record on: 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.
127 services126 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.
115 services115 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.
16 services16 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.
16 services16 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Co Of Michigan carries, from the Medicare DMEPOS supplier directory.

Kroger Co Of Michigan

DMEPOS supplier · Saint Clair Shores, MI
✔

Accepts Medicare assignment

Kroger Co Of Michigan 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)20410823
Medicare Participant SinceNovember 5, 2020
Supplier Location22801 Harper AveSaint Clair Shores, MI 48080
Phone(586) 800-5190
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 4

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

MEGHAN LAKOSKY
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
22801 HARPER AVE
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 800-5190
TAMARA BODAGH
Pharmacist
22801 HARPER AVE
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 800-5190
MR. RAYMOND TODD ALLARD RPH
Pharmacist
22801 HARPER AVE
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 779-4340
NOURA NAJOR
Pharmacist
22801 HARPER AVE
SAINT CLAIR SHORES, MI 48080
Macomb County (586) 800-5200

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 1154521060. It was assigned to this organization in the NPPES registry on July 19, 2007. The provider is doing business as Kroger Pharmacy #749.

Where is Kroger Co Of Michigan located?

Kroger Co Of Michigan is located at 22801 Harper Ave, St. Clair Shores, MI 48080. The listed phone number is (586) 800-5190.

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 Co Of Michigan 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 23D2077075) 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 June 14, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.