Walgreen Co
Organization Active NPI Pharmacy · Kansas City, MO
NPI 1265449276 · NPPES record last updated Mar 31, 2022
Key facts
- NPI
- 1265449276
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 2000148122 (MO)
- Legal business name
- WALGREEN CO
- Practice address
- 4630 Troost Ave
Kansas City, MO 64110-1712 - Phone
- (816) 931-8337
- NPI assigned
- Aug 2, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC.
Authorized official
- Name
- Kira L Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Member of 16
Practitioners 3
-
William Michael Burke, PHARMD
-
Ivan E Ferguson Jr., PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, MO
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 |
| O20201208002361 | MO | Part B Supplier - Independent Clinical Laboratory | 0941278253 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Walgreens Holding Company
Locations
4630 Troost Ave
Kansas City, MO 64110
Phone (816) 931-8337
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 2000148122 | MO | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
4630 Troost Ave
Kansas City, MO 64110-1712
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 624857900 DME | Medicaid | MO | |
| 2632962 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 604857904 | Medicaid | MO |
Other names
- WALGREENS #04211
Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 31, 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.