NPIMap

Organization Active NPI

Walgreen Co.

Doing business as Walgreens #13119

  • Pharmacy
  • Lahaina, HI
National Provider Identifier
1629229232
Registry record updated Mar 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHY-760 Issued in HI
Legal business name
WALGREEN CO.
Doing business as
Walgreens #13119
Practice address
843 Wainee St
Suite 109
Lahaina, HI 96761-1685
Phone
(808) 661-3119
NPI assigned
Oct 2, 2008
Organization subpart
Yes
Parent organization
WALGREEN CO.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2009

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

Authorized official

Name
Mr. Kermit R Crawford
Title
Senior Vice President
Phone
(217) 554-8964

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X PHY-760 HI Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

843 Wainee St
Suite 109
Lahaina, HI 96761-1685

Mailing address

1901 E Voorhees St
Ms 720
Danville, IL 61834-4509
Phone (217) 554-8964

Other identifiers 2

IdentifierTypeStateIssuer
62859701MedicaidHI
1240213OtherNCPDP

Other names 1

  • Walgreens #13119 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, HI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment
O20100930055165 HI DME Supplier - Pharmacy 0941278253 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lahaina, HI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Walgreens 01920

Member of 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236297600000",
    "number": "1629229232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MS 720",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "217-554-8964",
            "fax_number": "217-554-8546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "843 WAINEE ST",
            "address_2": "SUITE 109",
            "city": "LAHAINA",
            "state": "HI",
            "postal_code": "967611685",
            "telephone_number": "808-661-3119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREEN CO.",
        "enumeration_date": "2008-10-02",
        "last_updated": "2009-03-06",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "KERMIT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "217-554-8964",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "HI",
            "license": "PHY-760",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "62859701",
            "state": "HI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1240213",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walgreens #13119",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lahaina, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2009; 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.