KROGER PHARMACY
NPI 1710050331
Pharmacy - Community/Retail Pharmacy in Peoria, IL
NPI Status: Active since November 15, 2006
Contact Information
3311 N STERLING AVE
PEORIA, IL
ZIP 61604
Phone: (309) 679-2855
Fax: (309) 679-2856
- Organization
- Pharmacy
- Community/Retail Pharmacy
- Accepts Insurance
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 14D1078330
- CLIA Cert. Type: Pharmacy
- CLIA Exp. Date: 03-10-2027
About KROGER PHARMACY
This page provides the complete NPI Profile along with additional information for Kroger Pharmacy, a provider established in Peoria, Illinois operating as a Pharmacy, focusing in community/retail pharmacy . The healthcare provider is registered in the NPI registry with number 1710050331 assigned on November 2006. The practitioner's primary taxonomy code is 3336C0003X with license number 054011031 (IL). The provider is registered as an organization and their NPI record was last updated 10 years ago. The provider's is doing business as Kroger Pharmacy. The authorized official of this NPI record is Allison Muennich (Manager Of Pharmacy Licensing)
- NPI
- 1710050331
- Provider Legal Name
- KROGER LIMITED PARTNERSHIP I
- Other Organization Name
- KROGER PHARMACY
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 3311 N STERLING AVE PEORIA, IL 61604
- Location Phone
- (309) 679-2855
- Location Fax
- (309) 679-2856
- Mailing Address
- PO BOX 842772 BOSTON, MA 02284
- Mailing Phone
- (513) 762-1019
- Mailing Fax
- (309) 679-2856
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-15-2006
- Last Update Date
- 05-18-2016
- Code Navigator
Kroger Pharmacy is a medicare supplier with PTAN 20597375 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Immunosuppressive Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Commodes, Urinals, Bedpans or Blood Glucose Monitors/Supplies (Non-Mail Order) or Canes and/or Crutches or Walkers or Ostomy Supplies or Urological Supplies or Enteral Nutrients or Enteral Equipment and/or Supplies or Nebulizer Equipment and/or Supplies or Surgical Dressings.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pharmacy Community/Retail Pharmacy
- Taxonomy Code
- 3336C0003X
- Type
- Suppliers
- License No.
- 054011031
- License State
- IL
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| 2 | 333600000X | Suppliers | Pharmacy |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- AvMed Entrust Bronze 600 (2026) - HMO
- AvMed Entrust Bronze 650 (2026) - HMO
- AvMed Entrust Expanded Bronze Standard (2026) - HMO
- AvMed Entrust Gold 125 (2026) - HMO
- AvMed Entrust Gold 125 Dental+Vision (2026) - HMO
- AvMed Entrust Gold Standard (2026) - HMO
- AvMed Entrust Platinum 25 (2026) - HMO
- AvMed Entrust Platinum 25 Dental+Vision (2026) - HMO
- AvMed Entrust Platinum Standard (2026) - HMO
- AvMed Entrust Silver 350 (2026) - HMO
- Humana Dental Smart Choice - PPO
- Humana Dental Smart Choice - High - PPO
- Humana Dental Smart Choice - Lite - PPO
- Humana Dental Smart Choice - Low - PPO
- Select by Medica Bronze $0 Copay PCP Visits - EPO
- Select by Medica Bronze Share - EPO
- Select by Medica Expanded Bronze Standard - EPO
- Select by Medica Gold $0 Copay PCP Visits - EPO
- Select by Medica Gold Share - EPO
- Select by Medica Gold Standard - EPO
- Select by Medica Silver $0 Copay PCP Visits - EPO
- Select by Medica Silver Share - EPO
- Select by Medica Silver Standard - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 2021112 | OTHER (01) | PK | |
| =========942 | MEDICAID (05) | IL | |
| P00637372 | MEDICARE PIN (08) | ||
| IL1029 | MEDICARE PIN (08) | ||
| 1193770012 | MEDICARE NSC (07) |
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Administration of influenza virus vaccine
Influenza vaccine split virus, preservative free
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.
This service was performed 54 times for 54 patientsThe 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.
This service was performed 51 times for 51 patientsMedical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20597375
- Accepts Medicare Assignment
- YES
- Specialities List
- Pharmacy, Grocery Store.
- Competitive Bidding
- NO
Supplies List
- 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
- Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
- Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
- Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
- Urological Supplies - Catheters, Urinary collection devices
- Enteral Nutrients - Enteral formula
- Enteral Equipment and/or Supplies - Enteral infusion pumps, enteral nutrition supply kits
- Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
- Surgical Dressings - Gauze, Elastic bandages, Adhesive tape
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D1078330
- Facility Type
- Pharmacy
- Certificate Effective Date
- March 11, 2025
- Certificate Expiration Date
- March 10, 2027
- Laboratory Director
- LINDA M. SEWELL-WILSON
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Kroger Pharmacy to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1710050331, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 49. The final step is to find the difference between that total and the next multiple of ten (50 - 49 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 49 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1710050331, enumerated as an "organization" on November 15, 2006.
The provider is located at 3311 N STERLING AVE PEORIA, IL 61604 and the phone number is (309) 679-2855.
Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.
The provider might be accepting Accepts: AvMed, Humana, Medica, Moda Health Plan, Inc.,. Please consult your insurance carrier or call the provider to verify.
