NPIMap

Organization Active NPI

Walgreens Specialty Pharmacy LLC

Doing business as Walgreens Specialty Pharmacy #16287

  • Pharmacy
  • Pittsburgh, PA
National Provider Identifier
1972560688
Registry record updated Sep 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
PP415372L Issued in PA
Legal business name
WALGREENS SPECIALTY PHARMACY LLC
Doing business as
Walgreens Specialty Pharmacy #16287
Practice address
130 Enterprise Dr
Pittsburgh, PA 15275
Phone
(412) 413-8000
Fax
(877) 231-8302
NPI assigned
Apr 27, 2006
Last updated
Sep 30, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2024

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

Authorized official

Name
Jennifer Ponce
Title
Manager
Phone
(847) 527-2489

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X PP415372L PA Primary
Home Infusion Therapy Pharmacy 3336H0001X
Specialty Pharmacy 3336S0011X

Addresses

Primary practice location

130 Enterprise Dr
Pittsburgh, PA 15275

Mailing address

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

Other identifiers 49

IdentifierTypeStateIssuer
0216524MedicaidOH
1482567MedicaidND
1972560688MedicaidCA
1972560688MedicaidID
1972560688MedicaidME
6001307000MedicaidWV
81777100MedicaidDC
0395461MedicaidNC
12779024MedicaidNM
214642MedicaidMT
250622245MedicaidDE
001963828-0008MedicaidPA
1010753MedicaidVT
164561MedicaidAL
1972560688MedicaidMN
200333400AMedicaidKS
3102009MedicaidNH
7100162270MedicaidKY
100512960MedicaidNV
131971000MedicaidWY
1972560688MedicaidVA
1972560688MedicaidMO
4048229-00MedicaidMD
WA95680MedicaidRI
003135804MedicaidCT
003159944AMedicaidGA
0039683MedicaidNJ
10026155500MedicaidNE
1028415MedicaidAK
3974157OtherNCPDP
85885851MedicaidCO
110103221BMedicaidMA
3974157MedicaidTN
500603393MedicaidOR
580138MedicaidTX
875403MedicaidAZ
03904592MedicaidNY
04755357MedicaidMS
100002237MedicaidWI
1972560688MedicaidUT
1972560688MedicaidMI
1972560688MedicaidIA
200094500AMedicaidOK
2202847MedicaidLA
P11046424MedicaidWA
163032407MedicaidAR
200463010AMedicaidIN
779978MedicaidHI
7P372LMedicaidSC

Other names 1

  • Walgreens Specialty Pharmacy #16287 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930012092 PA DME Supplier - PharmacyDME Supplier - Medical Supply Company With Registered Pharmacist 5597972232 Practice locations: Pittsburgh, PA
O20230517000035 PA Part B Supplier - Pharmacy 5597972232 1 other NPI on this enrollment
Practice locations: Pittsburgh, PA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Walgreen Specialty Pharmacy LLC17 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

View all 16

Member of 1

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

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727654400000",
    "number": "1972560688",
    "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": "130 ENTERPRISE DR",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "15275",
            "telephone_number": "412-413-8000",
            "fax_number": "877-231-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREENS SPECIALTY PHARMACY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-04-27",
        "last_updated": "2024-09-30",
        "certification_date": "2024-09-30",
        "status": "A",
        "authorized_official_last_name": "PONCE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-527-2489"
    },
    "taxonomies": [
        {
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            "taxonomy_group": "",
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            "license": null,
            "primary": false
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            "license": "PP415372L",
            "primary": true
        },
        {
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            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": null,
            "license": null,
            "primary": false
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        {
            "code": "3336S0011X",
            "taxonomy_group": "",
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            "primary": false
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    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walgreens Specialty Pharmacy #16287",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsburgh, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2024; 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.