NPIMap

Organization Active NPI

Walgreen Co

Doing business as Jim Myers, A Walgreens Pharmacy #15448

  • Pharmacy
  • Tuscaloosa, AL
National Provider Identifier
1740547462
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
113925 Issued in AL
Legal business name
WALGREEN CO
Doing business as
Jim Myers, A Walgreens Pharmacy #15448
Practice address
3325 University Blvd E
Tuscaloosa, AL 35404-4339
Phone
(205) 556-3800
NPI assigned
Apr 19, 2012
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 15, 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
Pharmacy 333600000X 113925 AL Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

3325 University Blvd E
Tuscaloosa, AL 35404-4339

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
1740547462MedicaidAL
0137819OtherNCPDP

Other names 1

  • Jim Myers, A Walgreens Pharmacy #15448 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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1334793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1452816000000",
    "number": "1740547462",
    "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": "3325 UNIVERSITY BLVD E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354044339",
            "telephone_number": "205-556-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2012-04-19",
        "last_updated": "2016-01-15",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AL",
            "license": "113925",
            "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": "1740547462",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0137819",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jim Myers, A Walgreens Pharmacy #15448",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 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.