Walgreen Eastern Co Inc
Organization Active NPI Pharmacy · Saugus, MA
NPI 1174538375 · NPPES record last updated Oct 27, 2023
Key facts
- NPI
- 1174538375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 2117 (MA)
- Legal business name
- WALGREEN EASTERN CO INC
- Practice address
- 1228 Broadway
Saugus, MA 01906-4194 - Phone
- (781) 233-6768
- NPI assigned
- Jul 29, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC
Authorized official
- Name
- Kira Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Corporate family (same tax ID) 23
Member of 3
Practitioners 6
-
Donna L Cunneen, RPH
-
Lucy U Dang, PHARMD
-
Rebecca Lee Stephanakis, PHARMD
-
Robert Viercinski, PHARMD.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walgreens #2577 |
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 (2 enrollments) in TX, MA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071211000174 | TX | Part B Supplier - Centralized Flu Biller | 7618929993 | This NPI is an additional NPI on the enrollment |
| O20100930018694 | MA | DME Supplier - Pharmacy | 7618929993 | Practice locations: Saugus, MA |
National Provider Directory
- Tax ID family
- Walgreens Pharmacy 1869
- Part of
- Walgreens Holding Company
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 2117 | MA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1228 Broadway
Saugus, MA 01906-4194
Mailing address
1901 E Voorhees St # Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2231443 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 110000111M | Medicaid | MA | |
| 0439584 | Medicaid | MA |
Other names
- WALGREENS #02577
Other providers in Saugus, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 27, 2023. 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.
- 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.