KROGER PHARMACY – Community/Retail Pharmacy, NPI 1336212950
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for KROGER PHARMACY
PO Box 846028, Albany Street, Church Green, Financial District, Boston, Suffolk County, Massachusetts, 02284-6028, United States
BOSTON, MA 022842772
Phone: (513) 762-1019
Fax: (513) 762-1092
Type: Mailing
Kroger, 2110, East Southlake Boulevard, Southlake, Tarrant County, Texas, 76092, United States
SOUTHLAKE, TX 760926506
Phone: (817) 421-7487
Fax: (817) 251-8715
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-09-30
PECOS data refreshed: 2026-06-15
Medicare revalidation (CMS due date list)
Revalidation due soon
Earliest CMS due date is 2026-07-31 (45 days away).
Enrollment records
1
Earliest due date
2026-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20100930041953 | O | Pharmacy | TX | 2026-07-31 |
What to do next
- Confirm the due date on the CMS Revalidation Lookup Tool.
- Complete revalidation in PECOS before the published due date.
- If you have multiple enrollment records, revalidate each one on its own schedule.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| G0008 | Administration of influenza virus vaccine | 271 | 271 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 268 | 268 | $0 |
| K1034 | Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count | 160 | 18 | $0 |
| 90480 | Admn sarscov2 vacc 1 dose | 109 | 109 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 68 | 68 | $0 |
Insurance plans in this area (ZIP 02284)
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