NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #03035

  • Pharmacy
  • Albuquerque, NM
National Provider Identifier
1720093628
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
P1313 Issued in NM
Legal business name
WALGREEN CO
Doing business as
Walgreens #03035
Practice address
6201 Central Ave NE
Albuquerque, NM 87108-1806
Phone
(505) 217-9907
NPI assigned
Jul 29, 2006
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREEN COAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Mr. Kermit R. Crawford
Title
Sr. Vice President
Phone
(847) 914-3154

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X P1313 NM Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

6201 Central Ave NE
Albuquerque, NM 87108-1806

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
1210382MedicaidLA
36265973003MedicaidNE
56754MedicaidNM
3200083OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • Walgreens #03035 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 01920

Member of 13

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

View all 13

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1720093628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MAILSTOP #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": "6201 CENTRAL AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871081806",
            "telephone_number": "505-217-9907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREEN CO",
        "enumeration_date": "2006-07-29",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "CRAWFORD",
        "authorized_official_first_name": "KERMIT",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT",
        "authorized_official_telephone_number": "847-914-3154",
        "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": "NM",
            "license": "P1313",
            "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": "1210382",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36265973003",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "56754",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3200083",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walgreens #03035",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.