Walgreen Co
Organization Active NPI Pharmacy · Canastota, NY
NPI 1477077618 · NPPES record last updated May 11, 2022
Key facts
- NPI
- 1477077618
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 036168 (NY)
- Legal business name
- WALGREEN CO
- Practice address
- 423 S Peterboro St
Canastota, NY 13032-1431 - Phone
- (315) 697-7595
- Fax
- (315) 697-9618
- NPI assigned
- Jul 31, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC
Authorized official
- Name
- Kira Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Parent organization (reported in NPPES) 1
Member of 16
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| 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
- Part of
- Walgreens Holding Company
Locations
423 S Peterboro St
Canastota, NY 13032
Phone (315) 697-7595
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 036168 | NY | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
423 S Peterboro St
Canastota, NY 13032-1431
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04991379 | Medicaid | NY | |
| 5822196 | Other | NY | NCPDP |
Other names
- Walgreens #17213
Other providers in Canastota, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 11, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.