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KROGER PHARMACY
NPI 1164447868
Pharmacy - Community/Retail Pharmacy in Jackson, MS

Active since July 13, 2006CLIA 25D1021493 · Waiver
3520 TERRY RD, JACKSON, MS 39212(601) 371-5067(601) 371-5071 Get Directions Write a Review

NPPES record last updated: April 7, 2014. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Kroger Pharmacy NPPES

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

KROGER PHARMACY (NPI 1164447868) is a healthcare organization registered as a community/retail pharmacy in Jackson, Mississippi and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through January 22, 2028 and lists Karla Langworthy, Manager Of Pharmacy Credentialing, as its authorized official.

NPPES Registry Identity

NPI1164447868
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER LIMITED PARTNERSHIP I
Location Address3520 TERRY RDJackson, MS 39212-4943
Mailing Address800 Ridge Lake BlvdMemphis, TN 38120-9427 · (901) 765-4157 · Fax (901) 765-4213
Phone(601) 371-5067
Fax(601) 371-5071
Organization SubpartNo
Authorized OfficialKarla LangworthyManager Of Pharmacy Credentialing · (513) 698-1878
Enumeration DateJuly 13, 2006
Last NPPES UpdateApril 7, 2014
✔ NPI 1164447868 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 MS · 0227401KJ
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
3520 TERRY RD, Jackson, MS 39212
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Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 4

Medicare PIN730000003
Medicare NSC1193770115
Other2045345Pk
Medicaid00330561MS

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 25D1021493

Kroger Pharmacy #345 · Jackson, MS
Active · expires Jan 22, 2028
CLIA Number25D1021493
Laboratory TypePharmacy
Certificate Effective DateJanuary 23, 2026
Certificate Expiration DateJanuary 22, 2028
Laboratory DirectorCynthia B. Fisher
Laboratory Phone(601) 366-6554
Laboratory LocationKroger Pharmacy #3454910 I-55 North, Jackson, MS 39211
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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 1164447868. It was assigned to this organization in the NPPES registry on July 13, 2006. The provider is doing business as Kroger Pharmacy.

Where is Kroger Limited Partnership I located?

Kroger Limited Partnership I is located at 3520 Terry Rd, Jackson, MS 39212. The listed phone number is (601) 371-5067.

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 25D1021493) is associated with this NPI, valid through January 22, 2028. 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 April 7, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.