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SCOTTS PHARMACY J412
NPI 1689879074
Pharmacy - Community/Retail Pharmacy in Fort Wayne, IN

Active since June 18, 2007CLIA 15D1077777 · Waiver
1125 W STATE BLVD, FORT WAYNE, IN 46808(260) 426-4487(260) 424-3079 Get Directions Write a Review

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

About Scotts Pharmacy J412 NPPES

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

SCOTTS PHARMACY J412 (NPI 1689879074) is a healthcare organization registered as a community/retail pharmacy in Fort Wayne, Indiana and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through December 18, 2027 and lists Allison Muennich, Manager Of Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1689879074
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER LIMITED PARTNERSHIP I
Location Address1125 W STATE BLVDFort Wayne, IN 46808-3185
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(260) 426-4487
Fax(260) 424-3079
Organization SubpartNo
Authorized OfficialAllison MuennichManager Of Pharmacy Licensing · (513) 762-1019
Enumeration DateJune 18, 2007
Last NPPES UpdateMay 16, 2016
✔ NPI 1689879074 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPharmacy · Community/Retail PharmacySuppliers
Taxonomy Code3336C0003X
License✔ Licensed in IN · 60006089A
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.
1125 W STATE BLVD, Fort Wayne, IN 46808
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Other Names 1

Doing Business AsScotts Pharmacy J412

Other Identifiers 5

Medicaid200872440AIN
Medicare NSC1193770686
Other2025510Pk
Medicare PINP00637372
Medicare PIN256660

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 15D1077777

Scotts Pharmacy #412 · Fort Wayne, IN
Active · expires Dec 18, 2027
CLIA Number15D1077777
Laboratory TypePharmacy
Certificate Effective DateDecember 19, 2025
Certificate Expiration DateDecember 18, 2027
Laboratory DirectorRon Miller
Laboratory Phone(260) 426-4487
Laboratory LocationScotts Pharmacy #4121125 W State, Fort Wayne, IN 46808
CLIA data matches this NPI record on: Address 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.
88 services88 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.
78 services78 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.
25 services25 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.
24 services24 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Scott's Pharmacy J-412 carries, from the Medicare DMEPOS supplier directory.

Scott's Pharmacy J-412

DMEPOS supplier · Fort Wayne, INOperated by Kroger Limited Partnership I
✔

Accepts Medicare assignment

Scott's Pharmacy J-412 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)20596157
Medicare Participant SinceAugust 27, 2003
Supplier Location1125 W State BlvdFort Wayne, IN 46808
Phone(260) 426-4487
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 3

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

DONALD HENRY
Pharmacist
1125 W STATE BLVD
FORT WAYNE, IN 46808
Allen County (260) 426-4487
RONALD LYNN MILLER
Pharmacist
1125 W STATE BLVD
FORT WAYNE, IN 46808
Allen County (269) 426-4487
DR. KELSEA MAY LOPEZ RPH, PHARM D
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
1125 W STATE BLVD
FORT WAYNE, IN 46808
Allen County (260) 426-4487

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 1689879074. It was assigned to this organization in the NPPES registry on June 18, 2007. The provider is doing business as Scotts Pharmacy J412.

Where is Kroger Limited Partnership I located?

Kroger Limited Partnership I is located at 1125 W State Blvd, Fort Wayne, IN 46808. The listed phone number is (260) 426-4487.

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 accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Scott's Pharmacy J-412 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Kroger Limited Partnership I hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 15D1077777) is associated with this NPI, valid through December 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kroger Limited Partnership I 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 45 other insurers list Kroger Limited Partnership I 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 Limited Partnership I 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.