NPIMap

Organization Active NPI

Walgreen Co

  • Pharmacy
  • Beaumont, TX
National Provider Identifier
1114932175
Registry record updated Feb 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
10642 Issued in TX
Legal business name
WALGREEN CO
Practice address
3990 E Lucas Dr
Beaumont, TX 77708-5513
Phone
(409) 898-2990
Fax
(409) 898-3471
NPI assigned
Jul 29, 2006
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kira L Taylor
Title
Manager
Phone
(217) 709-2351

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 10642 TX Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

3990 E Lucas Dr
Beaumont, TX 77708-5513

Mailing address

1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351

Other identifiers 3

IdentifierTypeStateIssuer
4503505OtherOTHER ID NUMBER-COMMERCIAL NUMBER
462212MedicaidTX
468516MedicaidTX

Other names 1

  • WALGREENS #03271 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment
O20200925001561 TX Part B Supplier - Independent Clinical Laboratory 0941278253 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Walgreens Holding Company

Member of 16

Organizations this organization is a member of, according to the National Provider Directory.

View all 16

Locations

3990 E Lucas Dr
Beaumont, TX 77708
Phone (409) 898-2990

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676592000000",
    "number": "1114932175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MS 790",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "217-709-2351",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3990 E LUCAS DR",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777085513",
            "telephone_number": "409-898-2990",
            "fax_number": "409-898-3471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-07-29",
        "last_updated": "2023-02-17",
        "certification_date": "2023-02-17",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KIRA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-709-2351"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "10642",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "4503505",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "462212",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "468516",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #03271",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #03271",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaumont, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.