KROGER PHARMACY
NPI 1710911433
Pharmacy - Community/Retail Pharmacy in Toledo, OH

Q: What is the provider's specialty?

The provider's specialty is Pharmacy with taxonomy code 3336C0003X and a focus in Community/Retail Pharmacy.

Active since July 10, 2006CLIA 36D2113898 · Waiver

4633 SUDER AVE, TOLEDO, OH 43611(419) 727-2650(419) 727-2651 Get Directions Write a Review

NPPES record last updated: February 5, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Feb 5, 2020, May 16, 2016 (2 updates tracked since 2016).

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About Kroger Pharmacy NPPES

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

KROGER PHARMACY (NPI 1710911433) is a healthcare organization registered as a community/retail pharmacy in Toledo, Ohio and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through June 1, 2028 and lists Jessie Warman, Manager Pharmacy Licensing, as its authorized official.

NPPES Registry Identity

NPI1710911433

Entity TypeOrganization

Primary Taxonomy3336C0003X

Legal Business NameTHE KROGER CO

Location Address4633 SUDER AVEToledo, OH 43611-1829

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

Phone(419) 727-2650

Fax(419) 727-2651

Organization SubpartNo

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

Enumeration DateJuly 10, 2006

Last NPPES UpdateFebruary 5, 20202 updates tracked since enumeration

✔ NPI 1710911433 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 OH · 021544150

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

4633 SUDER AVE, Toledo, OH 43611

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Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 2

Medicaid2601992OH

Other2080319Pk

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 36D2113898

Kroger Pharmacy #617 · Toledo, OH

Active · expires Jun 1, 2028

CLIA Number36D2113898

Laboratory TypePharmacy

Certificate Effective DateJune 2, 2026

Certificate Expiration DateJune 1, 2028

Laboratory DirectorJeff Steckman

Laboratory Phone(419) 727-2650

Laboratory LocationKroger Pharmacy #6174633 Suder Ave, Toledo, OH 43611

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 5

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 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.

206 services203 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.

196 services193 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.

17 services17 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.

16 services16 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.

11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories The Kroger Co carries, from the Medicare DMEPOS supplier directory.

The Kroger Co

DMEPOS supplier · Oregon, OH

✔

Accepts Medicare assignment

The Kroger Co 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)20304113

Medicare Participant SinceOctober 18, 2023

Supplier Location3301 Navarre AveOregon, OH 43616

Phone(419) 691-7034

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 5

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

ROSS KWIATKOWSKI

Pharmacist