Active NPI
Walgreen Co.
Doing business as Walgreens #17113
- Clinical Medical Laboratory
- Buckhannon, WV
National Provider Identifier
1700504149
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- WALGREEN CO.
- Doing business as
- Walgreens #17113
- Practice address
- 71 W Main St
Buckhannon, WV 26201-2236 - Phone
- (304) 472-0150
- NPI assigned
- Aug 22, 2022
- Last updated
- Aug 22, 2022
- 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 L Taylor
- Title
- Manager
- Phone
- (217) 709-2351
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
71 W Main St
Buckhannon, WV 26201-2236
Mailing address
1901 E Voorhees St # Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351
Other names 1
- Walgreens #17113
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 51D2234277 | Walgreens #17113 | Certificate of waiver | Aug 29, 2027 |
National Provider Directory
National Provider Directory- Tax ID family
- Walgreen Co
- 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661126400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1661126400000",
"number": "1700504149",
"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": "217-709-2351",
"fax_number": "217-709-2344"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "71 W MAIN ST",
"city": "BUCKHANNON",
"state": "WV",
"postal_code": "262012236",
"telephone_number": "304-472-0150"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN CO.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
"enumeration_date": "2022-08-22",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A",
"authorized_official_last_name": "TAYLOR",
"authorized_official_first_name": "KIRA",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "217-709-2351"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Walgreens #17113",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Buckhannon, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.