Walgreen Co
Organization Active NPI Pharmacy · Corryton, TN
NPI 1013236785 · NPPES record last updated Oct 9, 2024
Key facts
- NPI
- 1013236785
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 4783 (TN)
- Legal business name
- WALGREEN CO
- Practice address
- 7425 Tazewell Pike
Corryton, TN 37721-3532 - Phone
- (865) 232-1811
- Fax
- (865) 232-1817
- NPI assigned
- May 20, 2010
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC
Authorized official
- Name
- Jennifer Ponce
- Title
- Manager
- Phone
- (847) 527-2489
Other NPIs on the same Medicare enrollment 9
Corporate family (same tax ID) 14
Member of 16
Practitioners 4
-
Kylie Moore, PHARMD
-
Dustin Craig Parrott, PHARMD
-
Brett P Carter, PHARMD
-
Benjamin Thomas Loomis, PHARM.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 44D2032491 | Walgreens #12980 | Certificate of waiver | Aug 29, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walgreens #12980 |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TX, TN
All facility ownership & control disclosures 77
| Facility | Type | Role | Since |
|---|---|---|---|
| At Home Care |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Adoration Home Health and Hospice Care East Tennessee |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | May 17, 2019 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Adoration Home Health Care Mississippi |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | May 17, 2019 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Option Care |
Home health agency | 5% Or Greater Direct Ownership Interest (49%) | Mar 31, 2015 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Adoration Home Health LLC |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Mar 5, 2019 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| @Heart Homecare |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Aug 1, 2022 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Adoration Home Health Nashville South |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Jan 1, 2021 |
| Adoration Home Health Martin |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Jan 13, 2025 |
| Adoration Home Health McMinnville |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Jan 1, 2021 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Mar 1, 2020 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Mar 1, 2020 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Mar 1, 2020 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Mar 1, 2020 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Mar 1, 2020 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Jan 1, 2021 |
| Adoration Home Health and Hospice |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Dec 30, 2024 |
| Adoration Home Health Baltimore |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Jan 9, 2025 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Aug 20, 2023 |
| Adoration Home Health Marlboro |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Aug 20, 2023 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Mar 1, 2023 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Feb 17, 2023 |
| Adoration Home Health |
Home health agency | 5% Or Greater Indirect Ownership Interest (29%) | Sep 1, 2024 |
| Adoration Home Health Care Rhode Island |
Home health agency | 5% Or Greater Indirect Ownership Interest (20%) | Sep 1, 2025 |
| Hospice of North Alabama, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Hospice Home Care of Pine Bluff, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Nov 1, 2021 |
| Adoration Home Health and Hospice Care Mississippi |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | May 17, 2019 |
| Hospice Home Care of Monticello |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Nov 1, 2021 |
| Springhill Home Health & Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Compassioncare Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Grane Hospice Care |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Oasis Healthcare, Inc. |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Grane Hospice Care |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Allay Home & Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Sep 2, 2021 |
| Hospice Home Care, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Nov 1, 2021 |
| Adoration Hospice Care Mississippi |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | May 17, 2019 |
| Adoration Home Health and Hospice Care East Tennessee |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | May 17, 2019 |
| Apreva Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Jan 30, 2024 |
| Ohio Valley Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Spring Valley Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Nov 1, 2021 |
| Adoration Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Grane Hospice Care |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Athc - Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| All Saints Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Nov 1, 2021 |
| Sacred Journey Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Dec 9, 2020 |
| Embrace Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Grane Hospice Care |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Abode Hospice of Colorado |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Abode Hospice of Colorado |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Hospice of the Midwest LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Adoration Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Mar 5, 2019 |
| Athc - Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Hospice of the Midwest |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Compassioncare Hospice Reno |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| @Heart Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Aug 1, 2022 |
| Embrace Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Spring Valley Hospice of Tupelo |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Nov 1, 2021 |
| Abode Hospice of Colorado |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Embrace Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest | Mar 5, 2019 |
| Sacred Journey Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Dec 9, 2020 |
| Athc - Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Embrace Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest | Mar 5, 2019 |
| Athc - Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Apr 16, 2021 |
| Abode Hospice of Colorado |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Generations Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Sep 2, 2021 |
| Adoration Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Jun 1, 2021 |
| Adoration Home Health and Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Sep 1, 2021 |
| Sacred Journey Hospice, LLC |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Dec 9, 2020 |
| Hospice of the Midwest |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Apr 16, 2021 |
| Adoration Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (29%) | Aug 20, 2023 |
| Haven Hospice |
Hospice | 5% Or Greater Indirect Ownership Interest (20%) | Sep 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070917000779 | TX | Part B Supplier - Centralized Flu Biller | 0941278253 | This NPI is an additional NPI on the enrollment |
| O20100930049132 | TN | DME Supplier - Pharmacy | 0941278253 | Practice locations: Corryton, TN |
| O20230426001407 | TN | Part B Supplier - Independent Clinical Laboratory | 0941278253 |
9 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Sevierville, TN; Murfreesboro, TN; Morristown, TN; Memphis, TN; Livingston, TN; Corryton, TN; Kingsport, TN; Ashland City, TN… |
National Provider Directory
- Tax ID family
- Walgreen Co
- Part of
- Walgreens Holding Company
Locations
7425 Tazewell Pike
Corryton, TN 37721
Phone (865) 232-1811
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 4783 | TN | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
7425 Tazewell Pike
Corryton, TN 37721-3532
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (847) 527-2489
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4443254 | Other | NCPDP |
Other names
- WALGREENS #12980
Other providers in Corryton, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.