KROGER PHARMACY – Community/Retail Pharmacy, NPI 1407871114
Community/Retail Pharmacy
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for KROGER PHARMACY
4925, Jackman Road, Deaveaux, Toledo, Lucas County, Ohio, 43613, United States
TOLEDO, OH 436133574
Phone: (419) 475-9103
Fax: (419) 475-9165
Type: Location
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
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 scheduled
Earliest CMS due date is 2026-09-30 (107 days away).
Enrollment records
1
Earliest due date
2026-09-30
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 |
|---|---|---|---|---|
| O20100930069494 | O | Pharmacy | OH | 2026-09-30 |
What to do next
- Monitor the published due date as it approaches.
- Plan to revalidate in PECOS within the window CMS allows before the due date.
- Verify the date on the CMS Revalidation Lookup Tool before submitting.
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 |
|---|---|---|---|---|
| 90480 | Admn sarscov2 vacc 1 dose | 99 | 99 | $0 |
| G0008 | Administration of influenza virus vaccine | 84 | 84 | $0 |
| 90662 | Influenza vaccine split virus, preservative free | 81 | 81 | $0 |
| 91322 | Sarscov2 vac 50 mcg/0.5ml im | 56 | 56 | $0 |
| 91320 | Sarscv2 vac 30mcg trs-suc im | 43 | 43 | $0 |
Insurance plans in this area (ZIP 43613)
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