Active NPI
Walgreen Co
- Pharmacy
- Jackson, MS
National Provider Identifier
1639677230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 17010
- Legal business name
- WALGREEN CO
- Doing business as
- Walgreens #21165
- Practice address
- 971 Lakeland Dr Ste 101
Jackson, MS 39216-4607 - Phone
- (601) 718-1898
- Fax
- (601) 718-1899
- NPI assigned
- Jan 29, 2018
- Organization subpart
- Yes
- Parent organization
- WALGREENS BOOTS ALLIANCE INC
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 | 17010 | MS | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
971 Lakeland Dr Ste 101
Jackson, MS 39216-4607
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08977310 | Medicaid | MS | |
| 2591611 | Other | MS | NCPDP |
Other names 1
- Walgreens #21165
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 |
National Provider Directory
National Provider Directory- Part of
- Walgreens Holding Company
Member of 16
Organizations this organization is a member of, according to the National Provider Directory.
-
- Home Infusion Therapy Pharmacy
- Sauk Rapids, MN
- NPI 1891746111
Member Of
-
- Home Infusion Therapy Pharmacy
- Nashville, TN
- NPI 1326279746
Member Of
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517184000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1655078400000",
"number": "1639677230",
"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": "971 LAKELAND DR STE 101",
"city": "JACKSON",
"state": "MS",
"postal_code": "392164607",
"telephone_number": "601-718-1898",
"fax_number": "601-718-1899"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN CO",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
"enumeration_date": "2018-01-29",
"last_updated": "2022-06-13",
"certification_date": "2022-06-13",
"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": "MS",
"license": "17010",
"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": "08977310",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPDP",
"identifier": "2591611",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Walgreens #21165",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Walgreens #21165",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; 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.