1. Home
  2. Directory
  3. Illinois
  4. Decatur
  5. Pharmacy
  6. NPI Profile

KROGER PHARMACY
NPI 1235202854
Pharmacy - Community/Retail Pharmacy in Decatur, IL

Active since November 15, 2006CLIA 14D1078332 · Waiver
1401 W KING ST, DECATUR, IL 62522(217) 429-0514(217) 429-0482 Get Directions Write a Review

NPPES record last updated: May 18, 2016. 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 1235202854) is a healthcare organization registered as a community/retail pharmacy in Decatur, Illinois and active in the NPI registry since November 2006. The organization holds a CLIA Waiver certificate valid through January 7, 2028 and lists Allison Muennich, Manager Of Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1235202854
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER LIMITED PARTNERSHIP I
Location Address1401 W KING STDecatur, IL 62522-1444
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(217) 429-0514
Fax(217) 429-0482
Organization SubpartNo
Authorized OfficialAllison MuennichManager Of Pharmacy Licensing · (513) 762-1019
Enumeration DateNovember 15, 2006
Last NPPES UpdateMay 18, 2016
✔ NPI 1235202854 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 IL · 054014229
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
1401 W KING ST, Decatur, IL 62522
Open in Google Maps ↗

Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 5

Medicaid=========250IL
Medicare PINIL1029
Other2025024Pk
Medicare NSC1193770722
Medicare PINP00637372

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 14D1078332

Kroger Pharmacy #922 · Decatur, IL
Active · expires Jan 7, 2028
CLIA Number14D1078332
Laboratory TypePharmacy
Certificate Effective DateJanuary 8, 2026
Certificate Expiration DateJanuary 7, 2028
Laboratory DirectorStacy P. Doyle
Laboratory Phone(217) 877-1327
Laboratory LocationKroger Pharmacy #9223070 N Water St, Decatur, IL 62526
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 1235202854. It was assigned to this organization in the NPPES registry on November 15, 2006. The provider is doing business as Kroger Pharmacy.

Where is Kroger Limited Partnership I located?

Kroger Limited Partnership I is located at 1401 W King St, Decatur, IL 62522. The listed phone number is (217) 429-0514.

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 14D1078332) is associated with this NPI, valid through January 7, 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 May 18, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.