Walgreen Co
Organization Active NPI Pharmacy · Medford, OR
NPI 1205043387 · NPPES record last updated Jun 13, 2022
Key facts
- NPI
- 1205043387
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- RP0002395CS (OR)
- Legal business name
- WALGREEN CO
- Practice address
- 210 E Barnett Rd
Medford, OR 97501-7928 - Phone
- (541) 858-3336
- NPI assigned
- May 17, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC
Authorized official
- Name
- Kira L Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Other NPIs on the same Medicare enrollment 31
Member of 16
Practitioners 10
-
Steven Lee Brammer, RPH
-
Steven Alan Collison, RPH, PHARMD
-
Benjamin Egendoerfer, PHARMD
-
Tiffany Hoenke, PHARM.D.
-
Alexandria Anne McHugh, PHARMD
-
Justin Ramsey, PHARMD
-
Robert Elkin McHugh, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, OR
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 |
| O20201206000041 | OR | Part B Supplier - Independent Clinical Laboratory | 0941278253 |
31 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Newport, OR; Ontario, OR; Portland, OR; Roseburg, OR; Salem, OR; Eugene, OR; Sandy, OR; Springfield, OR… |
National Provider Directory
- Part of
- Walgreens Holding Company
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | RP0002395CS | OR | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
210 E Barnett Rd
Medford, OR 97501-7928
Mailing address
1901 E Voorhees St
Mailstop #790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3842754 | Other | OTHER | |
| 006504 | Medicaid | OR |
Other names
- WALGREENS #09328
Other providers in Medford, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 13, 2022. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.