Active NPI
Walgreen Eastern Co, Inc
- Pharmacy
- Bridgeport, CT
National Provider Identifier
1285649533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 1418
- Legal business name
- WALGREEN EASTERN CO, INC
- Practice address
- 960 North Ave
Bridgeport, CT 06606-5750 - Phone
- (203) 334-6978
- NPI assigned
- Jul 29, 2006
- Organization subpart
- Yes
- Parent organization
- WALGREENS BOOTS ALLIANCE INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kira L Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 1418 | CT | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
960 North Ave
Bridgeport, CT 06606-5750
Mailing address
1901 E Voorhees St
Ms #790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0714039 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 004114055 | Medicaid | CT | |
| 004121000 DME | Medicaid | CT |
Other names 1
- WALGREENS #05723
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, CT
Enrollment records 2
| 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 |
| O20210125001959 | CT | Part B Supplier - Independent Clinical Laboratory | 7618929993 |
6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Willimantic, CT; Wethersfield, CT; North Haven, CT; Middletown, CT; Waterbury, CT |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Walgreens Holding Company
Member of 3
Organizations this organization is a member of, according to the National Provider Directory.
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": "1651104000000",
"number": "1285649533",
"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": "960 NORTH AVE",
"city": "BRIDGEPORT",
"state": "CT",
"postal_code": "066065750",
"telephone_number": "203-334-6978"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN EASTERN CO, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
"enumeration_date": "2006-07-29",
"last_updated": "2022-04-28",
"certification_date": "2022-04-28",
"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": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "CT",
"license": "1418",
"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": "0714039",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004114055",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004121000 DME",
"state": "CT"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WALGREENS #05723",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "WALGREENS #05723",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bridgeport, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.