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KROGER PHARMACY
NPI 1164456927
Pharmacy - Community/Retail Pharmacy in Commerce Township, MI

Active since July 10, 2006CLIA 23D1101953 · Waiver
47060 W PONTIAC TRL, COMMERCE TOWNSHIP, MI 48390(248) 960-8297(248) 960-8788 Get Directions Write a Review

NPPES record last updated: January 25, 2019. Verified against the NPPES registry weekly; last sync: July 19, 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 1164456927) is a healthcare organization registered as a community/retail pharmacy in Commerce Township, Michigan and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through July 7, 2027 and lists Jessie Warman, Manager Rx Licensing, as its authorized official.

NPPES Registry Identity

NPI1164456927
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER CO OF MICHIGAN
Location Address47060 W PONTIAC TRLCommerce Township, MI 48390-4030
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(248) 960-8297
Fax(248) 960-8788
Organization SubpartNo
Authorized OfficialJessie WarmanManager Rx Licensing · (513) 762-1090
Enumeration DateJuly 10, 2006
Last NPPES UpdateJanuary 25, 20192 updates tracked since enumeration
✔ NPI 1164456927 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 · 5301006233
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
47060 W PONTIAC TRL, Commerce Township, MI 48390
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Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 2

Other2042714Pk
Medicaid3119834MI

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 23D1101953

Kroger Pharmacy · Walled Lake, MI
Active · expires Jul 7, 2027
CLIA Number23D1101953
Laboratory TypePharmacy
Certificate Effective DateJuly 8, 2025
Certificate Expiration DateJuly 7, 2027
Laboratory DirectorRobert Brown
Laboratory Phone(248) 960-8297
Laboratory LocationKroger Pharmacy47060 Pontiac Trail Kroger Pharmacy 018-634 Attn Pharmacist In Charge, Walled Lake, MI 48390
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.
168 services167 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.
162 services161 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.
35 services35 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.
35 services35 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy 18634 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy 18634

DMEPOS supplier · Commerce Township, MIOperated by Kroger Co Of Michigan
✔

Accepts Medicare assignment

Kroger Pharmacy 18634 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)20410493
Medicare Participant SinceNovember 5, 2020
Supplier Location47060 W Pontiac TrlCommerce Township, MI 48390
Phone(248) 960-8297
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 2

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

JOHN FREDERICK RYSKAMP
Pharmacist
47060 W PONTIAC TRL
COMMERCE TWP, MI 48390
Oakland County (248) 960-8297
ALEXANDER JOHN GAMMO PHARMACIST
Pharmacist
47060 W PONTIAC TRL
COMMERCE TWP, MI 48390
Oakland County (248) 960-7730

Frequently Asked Questions

What is KROGER CO OF MICHIGAN's NPI number?

The NPI number assigned to this healthcare provider is 1164456927, enumerated as an "organization" on July 10, 2006.

Where is the provider located?

The provider is located at 47060 W PONTIAC TRL COMMERCE TOWNSHIP, MI 48390 and the phone number is (248) 960-8297.

What is the provider's specialty?

Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.

What insurance does KROGER CO OF MICHIGAN accept?

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Absolute. Please consult your insurance carrier or call the provider to verify.