NPIMap

Walgreen Co

Organization Active NPI Pharmacy · San Antonio, TX

NPI 1285649210 · NPPES record last updated Feb 28, 2023

Key facts

NPI
1285649210
Entity type
Organization (NPI type 2)
Primary specialty
Pharmacy 333600000X
License
17579 (TX)
Legal business name
WALGREEN CO
Practice address
2200 E Houston St
San Antonio, TX 78202-3007
Phone
(210) 354-3993
Fax
(210) 354-2496
NPI assigned
Jul 29, 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

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

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in TX

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment
O20201015002519 TX Part B Supplier - Independent Clinical Laboratory 0941278253 This NPI is an additional NPI on the enrollment

National Provider Directory

Part of
Walgreens Holding Company

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 17579 TX Yes
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

2200 E Houston St
San Antonio, TX 78202-3007

Mailing address

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

Other identifiers

IdentifierTypeStateIssuer
4599431OtherOTHER ID NUMBER-COMMERCIAL NUMBER
470845MedicaidTX
464028MedicaidTX

Other names

  • WALGREENS #04160 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 28, 2023.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677542400000",
    "number": "1285649210",
    "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": "2200 E HOUSTON ST",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782023007",
            "telephone_number": "210-354-3993",
            "fax_number": "210-354-2496"
        }
    ],
    "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": "2023-02-28",
        "certification_date": "2023-02-28",
        "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": "17579",
            "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": "4599431",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470845",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "464028",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #04160",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #04160",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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Sources for this page

Verify at the official NPI Registry.