NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #12604

  • Pharmacy
  • Atlanta, GA
National Provider Identifier
1710143169
Registry record updated Jan 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PHRE009535 Issued in GA
Legal business name
WALGREEN CO
Doing business as
Walgreens #12604
Practice address
340 Boulevard NE Ste 143
Atlanta, GA 30312-1278
Phone
(404) 525-8256
NPI assigned
Aug 5, 2008
Last updated
Jan 13, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2016

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

Authorized official

Name
Mr. Alan T Nielsen
Title
Treasurer
Phone
(847) 315-3523

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X PHRE009535 GA Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

340 Boulevard NE Ste 143
Atlanta, GA 30312-1278

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
842024867BOtherGAMEDICAID DME
1157684OtherNCPDP
842024867AMedicaidGA

Other names 1

  • WALGREENS #12604 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
Part of
Walgreens Holding Company

Member of 13

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

View all 13

Locations

340 Boulevard NE
Ste 143
Atlanta, GA 30312
Phone (404) 525-8256

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452643200000",
    "number": "1710143169",
    "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": "217-709-2386",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 BOULEVARD NE STE 143",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303121278",
            "telephone_number": "404-525-8256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2008-08-05",
        "last_updated": "2016-01-13",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "847-315-3523",
        "authorized_official_name_prefix": "Mr."
    },
    "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": "PHRE009535",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "842024867B",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "1157684",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "842024867A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #12604",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2016; 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.