KROGER PHARMACY #475
NPI 1700810546
Pharmacy - Community/Retail Pharmacy in Independence, KY

Q: What is Kroger Limited Partnership I's NPI number?

The NPI number for Kroger Limited Partnership I is 1700810546. It was assigned to this organization in the NPPES registry on July 10, 2006. The provider is doing business as Kroger Pharmacy #475.

Q: 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.

Active since July 10, 2006CLIA 18D2025859 · Waiver

1700 DECLARATION DR, INDEPENDENCE, KY 41051(859) 363-9020(859) 363-9107 Get Directions Write a Review

NPPES record last updated: February 4, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 4, 2020, Sep 15, 2016, May 16, 2016 (3 updates tracked since 2016).

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About Kroger Pharmacy #475 NPPES

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

KROGER PHARMACY #475 (NPI 1700810546) is a healthcare organization registered as a community/retail pharmacy in Independence, Kentucky and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through June 19, 2027 and lists Jessie Warman, Manager Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1700810546

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameKROGER LIMITED PARTNERSHIP I

Location Address1700 DECLARATION DRIndependence, KY 41051-8441

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

Phone(859) 363-9020

Fax(859) 363-9107

Organization SubpartNo

Authorized OfficialJessie WarmanManager Pharmacy Licensing · (513) 762-1090

Enumeration DateJuly 10, 2006

Last NPPES UpdateFebruary 4, 20203 updates tracked since enumeration

✔ NPI 1700810546 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 KY · P06390

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

1700 DECLARATION DR, Independence, KY 41051

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Other Names 1

Doing Business AsKroger Pharmacy #475

Other Identifiers 2

Medicaid54033907KY

Other2032994Pk

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 18D2025859

Kroger Pharmacy 014-475 · Independence, KY

Active · expires Jun 19, 2027

CLIA Number18D2025859

Laboratory TypeReatil Pharmacy

Certificate Effective DateJune 20, 2025

Certificate Expiration DateJune 19, 2027

Laboratory DirectorMs. Michelle Izor

Laboratory Phone(859) 898-1620

Laboratory LocationKroger Pharmacy 014-4751700 Declaration Drive, Independence, KY 41051

CLIA data matches this NPI record on: Address

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

Areas of Expertise CMS Part B claims 5

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.

212 services209 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.

202 services199 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.

18 services18 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.

17 services17 patients

Severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, preservative free, 5 mcg/0.5ml dosage, for intramuscular use 91304

The COVID-19 vaccine you'll receive is designed to protect against the virus. It contains tiny, harmless pieces of the virus's spike protein. These trigger your immune system to build a defense. The vaccine also includes a saponin-based adjuvant to enhance this response. It's given as a 0.5ml injection into a muscle.

17 services17 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy 475 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy 475

DMEPOS supplier · Independence, KYOperated by Kroger Limited Partnership I

✔

Accepts Medicare assignment

Kroger Pharmacy 475 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)20596343

Medicare Participant SinceAugust 27, 2003

Supplier Location1700 Declaration DrIndependence, KY 41051

Phone(859) 363-9020

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.

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Other Providers at the Same Location NPPES 14

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

BRANDY SULLIVAN BRANHAM FNP

Nurse Practitioner (Family)