NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #10031

  • Pharmacy
  • Chagrin Falls, OH
National Provider Identifier
1154336113
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
21555250 Issued in OH
Legal business name
WALGREEN CO
Doing business as
Walgreens #10031
Practice address
8535 Tanglewood SQ
Chagrin Falls, OH 44023-6461
Phone
(440) 543-3759
NPI assigned
Jul 29, 2006
Organization subpart
Yes
Parent organization
WALGREEN COAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

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

Authorized official

Name
Mr. Kermit R Crawford
Title
Coporate Vice President
Phone
(847) 914-3154

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 21555250 OH Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

8535 Tanglewood SQ
Chagrin Falls, OH 44023-6461

Mailing address

1901 E Voorhees St
Mailstop #720
Danville, IL 61834-4509
Phone (217) 554-8964

Other identifiers 2

IdentifierTypeStateIssuer
3673983OtherOTHER ID NUMBER-COMMERCIAL NUMBER
2615165MedicaidOH

Other names 1

  • WALGREENS #10031 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

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

National Provider Directory

National Provider Directory
Part of
Walgreens 16466

Member of 16

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

View all 16

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": "1213747200000",
    "number": "1154336113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MAILSTOP #720",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "217-554-8964",
            "fax_number": "217-554-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8535 TANGLEWOOD SQ",
            "city": "CHAGRIN FALLS",
            "state": "OH",
            "postal_code": "440236461",
            "telephone_number": "440-543-3759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREEN CO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "KERMIT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "COPORATE VICE PRESIDENT",
        "authorized_official_telephone_number": "847-914-3154",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "OH",
            "license": "21555250",
            "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": "3673983",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2615165",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #10031",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chagrin Falls, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.