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KROGER PHARMACY
NPI 1710911573
Pharmacy - Community/Retail Pharmacy in Roseville, MI

Active since July 10, 2006CLIA 23D2108065 · Waiver
26130 GRATIOT AVE, ROSEVILLE, MI 48066(586) 776-8966(586) 776-8583 Get Directions Write a Review

NPPES record last updated: January 25, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jan 25, 2019, May 16, 2016 (2 updates tracked since 2016).

About Kroger Pharmacy NPPES

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

KROGER PHARMACY (NPI 1710911573) is a healthcare organization registered as a community/retail pharmacy in Roseville, Michigan and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through January 27, 2028 and lists Jessie Warman, Manager Rx Licensing, as its authorized official.

NPPES Registry Identity

NPI1710911573
Entity TypeOrganization
Primary Taxonomy3336C0003X
Legal Business NameKROGER CO OF MICHIGAN
Location Address26130 GRATIOT AVERoseville, MI 48066-5111
Mailing AddressPo Box 842772Boston, MA 02284-2772 · (513) 762-1019 · Fax (513) 762-1092
Phone(586) 776-8966
Fax(586) 776-8583
Organization SubpartNo
Authorized OfficialJessie WarmanManager Rx Licensing · (513) 762-1090
Enumeration DateJuly 10, 2006
Last NPPES UpdateJanuary 25, 20192 updates tracked since enumeration
✔ NPI 1710911573 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 MI · 5301005449
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
26130 GRATIOT AVE, Roseville, MI 48066
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Other Names 1

Doing Business AsKroger Pharmacy

Other Identifiers 2

Medicaid2675380MI
Other2041032Pk

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 23D2108065

Kroger Pharmacy · Roseville, MI
Active · expires Jan 27, 2028
CLIA Number23D2108065
Laboratory TypePharmacy
Certificate Effective DateJanuary 28, 2026
Certificate Expiration DateJanuary 27, 2028
Laboratory DirectorRobert Brown
Laboratory Phone(586) 298-1855
Laboratory LocationKroger Pharmacy20891 E 13 Mile Road Kroger Pharmacy 018-774 Attn Pharmacist In Charge, Roseville, MI 48066
CLIA data matches this NPI record on: Name
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.

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.
46 services46 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.
41 services41 patients

Medical Equipment Supplier Medicare DMEPOS 14

Medicare supplier enrollment and the product categories Kroger Pharmacy 18663 carries, from the Medicare DMEPOS supplier directory.

Kroger Pharmacy 18663

DMEPOS supplier · Roseville, MIOperated by Kroger Co Of Michigan
✔

Accepts Medicare assignment

Kroger Pharmacy 18663 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)20410487
Medicare Participant SinceNovember 5, 2020
Supplier Location26130 Gratiot AveRoseville, MI 48066
Phone(586) 776-8583
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.

JONATHAN JONAH ISHOW
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
26130 GRATIOT AVE
ROSEVILLE, MI 48066
Macomb County (586) 776-8583
DR. JIMMY TRAN PHARMD
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
26130 GRATIOT AVE
ROSEVILLE, MI 48066
Macomb County (586) 776-8583
MISS ASOBARI AMACHREE PHARMD
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
26130 GRATIOT AVE
ROSEVILLE, MI 48066
Macomb County (586) 776-8583

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 Co Of Michigan's NPI number?

The NPI number for Kroger Co Of Michigan is 1710911573. It was assigned to this organization in the NPPES registry on July 10, 2006. The provider is doing business as Kroger Pharmacy.

Where is Kroger Co Of Michigan located?

Kroger Co Of Michigan is located at 26130 Gratiot Ave, Roseville, MI 48066. The listed phone number is (586) 776-8966.

What is Kroger Co Of Michigan's specialty?

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

Does Kroger Co Of Michigan accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Kroger Pharmacy 18663 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Kroger Co Of Michigan hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2108065) is associated with this NPI, valid through January 27, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Kroger Co Of Michigan 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 47 other insurers list Kroger Co Of Michigan 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 Co Of Michigan was last updated on January 25, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.