NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #12855

  • Pharmacy
  • Brooklyn, NY
National Provider Identifier
1437456753
Registry record updated Jan 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
030623 Issued in NY
Legal business name
WALGREEN CO
Doing business as
Walgreens #12855
Practice address
1511 86TH St
Brooklyn, NY 11228-3420
Phone
(347) 856-5679
NPI assigned
Feb 23, 2011
Last updated
Jan 25, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 25, 2019

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

Authorized official

Name
Alyssa Sweeten
Title
Manager
Phone
(217) 709-2386

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X 030623 NY Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

1511 86TH St
Brooklyn, NY 11228-3420

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
03341068MedicaidNY
5802029OtherNCPDP

Other names 1

  • WALGREENS #12855 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 14

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

View all 14

Locations

1511 86th St
Brooklyn, NY 11228
Phone (347) 856-5679

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1298419200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548374400000",
    "number": "1437456753",
    "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": "1511 86TH ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112283420",
            "telephone_number": "347-856-5679"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2011-02-23",
        "last_updated": "2019-01-25",
        "status": "A",
        "authorized_official_last_name": "SWEETEN",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-709-2386"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "030623",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03341068",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "5802029",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #12855",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #12855",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2019; 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.