KROGER PHARMACY
NPI 1417212820
Pharmacy - Community/Retail Pharmacy in Dallas, TX

Q: What is Kroger Texas LP's NPI number?

The NPI number for Kroger Texas LP is 1417212820. It was assigned to this organization in the NPPES registry on July 11, 2012. The provider is doing business as Kroger Pharmacy.

Q: What is Kroger Texas LP's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Q: When was this NPI record last updated?

The NPPES record for Kroger Texas LP was last updated on May 16, 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.

Active since July 11, 2012CLIA 45D2052095 · Waiver

4241 CAPITOL AVE, DALLAS, TX 75204(972) 338-3101(972) 338-3103 Get Directions Write a Review

NPPES record last updated: May 16, 2016. Verified against the NPPES registry weekly; last sync: August 02, 2026.

On this page

About Kroger Pharmacy NPPES

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

KROGER PHARMACY (NPI 1417212820) is a healthcare organization registered as a community/retail pharmacy in Dallas, Texas and active in the NPI registry since July 2012. The organization holds a CLIA Waiver certificate valid through January 3, 2027 and lists Allison Muennich, Manager Of Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1417212820

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameKROGER TEXAS LP

Location Address4241 CAPITOL AVEDallas, TX 75204-3635

Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092

Phone(972) 338-3101

Fax(972) 338-3103

Organization SubpartNo

Authorized OfficialAllison MuennichManager Of Pharmacy Licensing · (513) 762-1019

Enumeration DateJuly 11, 2012

Last NPPES UpdateMay 16, 2016

✔ NPI 1417212820 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers

Taxonomy Code3336C0003X

License✔ Licensed in TX · 28134

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

4241 CAPITOL AVE, Dallas, TX 75204

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Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 4

Medicare PINPH0426

Other2135969Pk

Medicare NSC1307140243

Medicaid1307140243TX

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 45D2052095

Kroger Pharmacy #529 Attn Pharmicist In Charge · Dallas, TX

Active · expires Jan 3, 2027

CLIA Number45D2052095

Laboratory TypePharmacy

Certificate Effective DateJanuary 4, 2025

Certificate Expiration DateJanuary 3, 2027

Laboratory DirectorJeff Loesch

Laboratory Phone(972) 338-3101

Laboratory LocationKroger Pharmacy #529 Attn Pharmicist In Charge4241 Capitol Ave, Dallas, TX 75204

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

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.

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.

48 services48 patients

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.

48 services48 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy #529 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy #529

DMEPOS supplier · Dallas, TXOperated by Kroger Texas L P

✔

Accepts Medicare assignment

Kroger Pharmacy #529 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)20631497

Medicare Participant SinceDecember 31, 1999

Supplier Location4241 Capitol AveDallas, TX 75204

Phone(972) 338-3101

Supplier Specialties

Pharmacy

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

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

CAMERON RAZAVI RPH

Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)

4241 CAPITOL AVE
DALLAS, TX 75204

Dallas County (972) 338-3101

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 Texas LP's NPI number?

The NPI number for Kroger Texas LP is 1417212820. It was assigned to this organization in the NPPES registry on July 11, 2012. The provider is doing business as Kroger Pharmacy.

Where is Kroger Texas LP located?

Kroger Texas LP is located at 4241 Capitol Ave, Dallas, TX 75204. The listed phone number is (972) 338-3101.

What is Kroger Texas LP's specialty?

The primary specialty registered for this NPI is Pharmacy, specializing in Community/Retail Pharmacy, with taxonomy code 3336C0003X.

Does Kroger Texas LP accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Kroger Pharmacy #529 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Kroger Texas LP hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 45D2052095) is associated with this NPI, valid through January 3, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kroger Texas LP 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 48 other insurers list Kroger Texas LP 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 Texas LP was last updated on May 16, 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.