NPIMap

Organization Active NPI

Walgreen Co

Doing business as Rite Aid #11711

  • Pharmacy
  • Marietta, GA
National Provider Identifier
1679097174
Registry record updated Apr 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHRE010518 Issued in GA
Legal business name
WALGREEN CO
Doing business as
Rite Aid #11711
Practice address
2200 Roswell Rd
Marietta, GA 30062-2983
Phone
(770) 973-7337
Fax
(770) 321-2594
NPI assigned
Jul 27, 2017
Last updated
Apr 30, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2018

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

Authorized official

Name
Alyssa Sweeten
Title
Manager
Phone
(217) 709-2386

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X PHRE010518 GA Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

2200 Roswell Rd
Marietta, GA 30062-2983

Mailing address

1901 E Voorhees St # Ms 790
Danville, IL 61834-4509
Phone (217) 709-2386

Other identifiers 2

IdentifierTypeStateIssuer
000396261AMedicaidGA
1171494OtherGANCPCP

Other names 1

  • RITE AID #11711 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Walgreen Co8,684 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

2200 Roswell Rd
Marietta, GA 30062
Phone (770) 565-6200

NPI Registry JSON

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1525046400000",
    "number": "1679097174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST # MS 790",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "217-709-2386",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 ROSWELL RD",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300622983",
            "telephone_number": "770-973-7337",
            "fax_number": "770-321-2594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2017-07-27",
        "last_updated": "2018-04-30",
        "status": "A",
        "authorized_official_last_name": "SWEETEN",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-709-2386"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "GA",
            "license": "PHRE010518",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000396261A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPCP",
            "identifier": "1171494",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "RITE AID #11711",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "RITE AID #11711",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; 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.