Active NPI
Walgreen Co.
Doing business as Walgreens #11577
- Pharmacy
- Uncasville, CT
National Provider Identifier
1437379005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- PCY0001934
- Legal business name
- WALGREEN CO.
- Doing business as
- Walgreens #11577
- Practice address
- 67 Sandy Desert Rd
Uncasville, CT 06382-1111 - Phone
- (860) 887-5189
- NPI assigned
- Apr 26, 2007
- Last updated
- Aug 5, 2011
- Organization subpart
- Yes
- Parent organization
- WALGREEN CO
NPPES NPI Registry
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
- Phone
- (847) 315-3154
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | PCY0001934 | CT | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
67 Sandy Desert Rd
Uncasville, CT 06382-1111
Mailing address
1901 E Voorhees St
Ms #790
Danville, IL 61834-4509
Phone (217) 709-2386
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0720804 | Other | NCPDP |
Other names 1
- WALGREENS #11577
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070917000779 | TX | Part B Supplier - Centralized Flu Biller | 0941278253 | This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Walgreen Co
- Part of
- Walgreens 01920
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1312502400000",
"number": "1437379005",
"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": "217-709-2386",
"fax_number": "217-709-2344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 SANDY DESERT RD",
"city": "UNCASVILLE",
"state": "CT",
"postal_code": "063821111",
"telephone_number": "860-887-5189"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN CO.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREEN CO",
"enumeration_date": "2007-04-26",
"last_updated": "2011-08-05",
"status": "A",
"authorized_official_last_name": "CRAWFORD",
"authorized_official_first_name": "KERMIT",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "847-315-3154",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "CT",
"license": "PCY0001934",
"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": "0720804",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WALGREENS #11577",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Uncasville, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.