Walgreen Co
Organization Active NPI Pharmacy · Holly Springs, GA
NPI 1780102913 · NPPES record last updated Apr 30, 2018
Key facts
- NPI
- 1780102913
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- PHRE010547 (GA)
- Legal business name
- WALGREEN CO
- Practice address
- 5329 Old Highway 5
Holly Springs, GA 30188-2431 - Phone
- (678) 494-9112
- Fax
- (678) 494-9538
- NPI assigned
- Sep 8, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS BOOTS ALLIANCE INC
Authorized official
- Name
- Alyssa Sweeten
- Title
- Manager
- Phone
- (217) 709-2386
Member of 16
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070917000779 | TX | Part B Supplier - Centralized Flu Biller | 0941278253 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Walgreens Holding Company
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | PHRE010547 | GA | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
5329 Old Highway 5
Holly Springs, GA 30188-2431
Mailing address
1901 E Voorhees St # Ms 790
Danville, IL 61834-4509
Phone (217) 709-2386
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000766466I | Medicaid | GA | |
| 1171329 | Other | GA | NCPDP |
Other names
- RITE AID #11758
Other providers in Holly Springs, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 30, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.