NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #13960

  • Pharmacy
  • Maxton, NC
National Provider Identifier
1306161534
Registry record updated Apr 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
10526 Issued in NC
Legal business name
WALGREEN CO
Doing business as
Walgreens #13960
Practice address
106 W Dr Martin Luther King Jr Dr
Maxton, NC 28364-1764
Phone
(910) 844-3096
Fax
(910) 844-3116
NPI assigned
Mar 31, 2010
Last updated
Apr 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 21, 2022

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

Authorized official

Name
Kira Taylor
Title
Manager
Phone
(217) 709-2351

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X 10526 NC Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

106 W Dr Martin Luther King Jr Dr
Maxton, NC 28364-1764

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
3419327OtherNCPDP
0785817MedicaidNC

Other names 1

  • WALGREENS #13960 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment
O20220802002389 NC Part B Supplier - Independent Clinical Laboratory 0941278253 9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Winston-Salem, NC; Elizabethtown, NC; Raleigh, NC; Mount Olive, NC; Maxton, NC; Kings Mountain, NC; Kannapolis, NC; Huntersville, NC…

Other NPIs on the same Medicare enrollment 9

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 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1269993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650499200000",
    "number": "1306161534",
    "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": "106 W DR MARTIN LUTHER KING JR DR",
            "city": "MAXTON",
            "state": "NC",
            "postal_code": "283641764",
            "telephone_number": "910-844-3096",
            "fax_number": "910-844-3116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2010-03-31",
        "last_updated": "2022-04-21",
        "certification_date": "2022-04-21",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KIRA",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NC",
            "license": "10526",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "3419327",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0785817",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #13960",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #13960",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Maxton, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 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.

Verify at the official NPI Registry.