Walgreen Co
Organization Active NPI Pharmacy · Houston, TX
NPI 1497760441 · NPPES record last updated Feb 27, 2023
Key facts
- NPI
- 1497760441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 10691 (TX)
- Legal business name
- WALGREEN CO
- Practice address
- 3822 Old Spanish TRL
Houston, TX 77021-1340 - Phone
- (713) 741-7323
- Fax
- (713) 741-3166
- NPI assigned
- Jul 29, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE
Authorized official
- Name
- Kira L Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Member of 16
Practitioners 7
-
Marvin Cleveland Henry I, PHARM .D
-
Vivian Maxine Johnson, PHARMACIST
-
Tot Thi Thanh Le, PHARM.D
-
Charlie Lee, RPH
-
Craig R Whitaker, PHARMD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) 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 |
| O20201210000103 | TX | Part B Supplier - Independent Clinical Laboratory | 0941278253 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Walgreens Holding Company
Locations
3822 Old Spanish Trl
Houston, TX 77021
Phone (713) 741-7323
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | |||
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 10691 | TX | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
3822 Old Spanish TRL
Houston, TX 77021-1340
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4500826 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 462241 | Medicaid | TX | |
| 468502 | Medicaid | TX |
Other names
- WALGREENS #11465
Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2023. 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.