NPIMap

Organization Active NPI

Walgreen Co.

Doing business as Walgreens #15119

  • Pharmacy
  • Richmond, VA
National Provider Identifier
1285795880
Registry record updated Apr 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
0201004125 Issued in VA
Legal business name
WALGREEN CO.
Doing business as
Walgreens #15119
Practice address
7101 Jahnke Rd
Ste 100
Richmond, VA 23225-4017
Phone
(804) 560-1092
NPI assigned
Dec 13, 2006
Organization subpart
Yes
Parent organization
WALGREEN COAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kermit R Crawford
Title
President, Pharmacy Services
Phone
(847) 315-3154

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 0201004125 VA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

7101 Jahnke Rd
Ste 100
Richmond, VA 23225-4017

Mailing address

1901 E Voorhees St
M/S 790
Danville, IL 61834-4509
Phone (217) 709-2386

Other identifiers 4

IdentifierTypeStateIssuer
4839695OtherVANCPDP
010374318 DMEMedicaidVA
010374359MedicaidVA
1285795880MedicaidVA

Other names 1

  • WALGREENS #15119 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

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

National Provider Directory

National Provider Directory
Part of
Walgreens 16466

Member of 16

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

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333929600000",
    "number": "1285795880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "M/S 790",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "217-709-2386",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7101 JAHNKE RD",
            "address_2": "STE 100",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232254017",
            "telephone_number": "804-560-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREEN CO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2012-04-09",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "KERMIT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRESIDENT, PHARMACY SERVICES",
        "authorized_official_telephone_number": "847-315-3154",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "VA",
            "license": "0201004125",
            "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": "NCPDP",
            "identifier": "4839695",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010374318 DME",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010374359",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1285795880",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #15119",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2012; 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.

Verify at the official NPI Registry.