Active NPI
Walgreen Co
Doing business as Pharmacy for Living Well
- Pharmacy
- Anaheim, CA
National Provider Identifier
1447696513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 51529
- Legal business name
- WALGREEN CO
- Doing business as
- Pharmacy for Living Well
- Practice address
- 1313 S Harbor Blvd
BLDG H-8 2ND Level
Anaheim, CA 92802-2309 - Phone
- (657) 208-5485
- Fax
- (714) 224-0172
- NPI assigned
- May 16, 2013
- Last updated
- May 3, 2022
- 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
- Kira Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 51529 | FL | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
1313 S Harbor Blvd
BLDG H-8 2ND Level
Anaheim, CA 92802-2309
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5647625 | Other | FL | NCPDP |
Other names 1
- Pharmacy for Living Well
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 |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2163794 | Pharmacy for Living Well | Certificate of waiver | Mar 20, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Bond Drug Company of Illinois LLC
- Part of
- Walgreens 01007
Other organizations with this tax ID 12
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Walgreens
- Community/Retail Pharmacy
- Deerfield, IL
- NPI 1669755484
-
- Community/Retail Pharmacy
- Deerfield, IL
- NPI 1114200938
-
- Pharmacist
- Chicago, IL
- NPI 1144598194
-
- Community/Retail Pharmacy
- Skokie, IL
- NPI 1457634057
-
- Point of Service
- Oak Forest, IL
- NPI 1912284811
Member of 4
Organizations this organization is a member of, according to the National Provider Directory.
Locations
1313 S Harbor Blvd
Bldg H8
Anaheim, CA 92802
Phone (657) 208-5485
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.
-
- Pharmacist
- Citrus Heights, CA
- NPI 1720363708
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1368662400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1651536000000",
"number": "1447696513",
"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": "1313 S HARBOR BLVD",
"address_2": "BLDG H-8 2ND LEVEL",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928022309",
"telephone_number": "657-208-5485",
"fax_number": "714-224-0172"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN CO",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREEN CO",
"enumeration_date": "2013-05-16",
"last_updated": "2022-05-03",
"certification_date": "2022-05-03",
"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": null,
"license": null,
"primary": false
},
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "FL",
"license": "51529",
"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": "5647625",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pharmacy for Living Well",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Pharmacy for Living Well",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.