NPIMap

Organization Active NPI

Walgreen Co.

  • Pharmacy
  • Forest, VA
National Provider Identifier
1417023375
Registry record updated Aug 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
0201003987 Issued in VA
Legal business name
WALGREEN CO.
Practice address
17421 Forest Rd
Forest, VA 24551-5020
Phone
(434) 316-5403
NPI assigned
Nov 24, 2006
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 17, 2016

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

Authorized official

Name
Mr. Alan T Nielsen
Title
Treasurer
Phone
(847) 315-3523

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 0201003987 VA Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

17421 Forest Rd
Forest, VA 24551-5020

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
010371368MedicaidVA
010090075 DMEMedicaidVA
4838225OtherNCPDP

Other names 1

  • WALGREENS #10105 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 Holding Company

Member of 16

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

View all 16

Locations

17421 Forest Rd
Forest, VA 24551
Phone (434) 316-5403

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1471392000000",
    "number": "1417023375",
    "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": "17421 FOREST RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "245515020",
            "telephone_number": "434-316-5403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-11-24",
        "last_updated": "2016-08-17",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "847-315-3523",
        "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": "0201003987",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010371368",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010090075 DME",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4838225",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #10105",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Forest, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; 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.