Walgreen Co
Organization Active NPI Pharmacy · Kinder, LA
NPI 1588023360 · NPPES record last updated Jul 30, 2018
Key facts
- NPI
- 1588023360
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- PHY.007284-RC (LA)
- Legal business name
- WALGREEN CO
- Practice address
- 287 Panther Trail
Kinder, LA 70648-6231 - Phone
- (337) 738-4170
- NPI assigned
- Feb 22, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC
Authorized official
- Name
- Alyssa Sweeten
- Title
- Manager
- Phone
- (217) 709-2386
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | PHY.007284-RC | LA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
287 Panther Trail
Kinder, LA 70648-6231
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2386
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1939252 | Other | LA | NCPDP |
Other providers in Kinder, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2018. 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.