NPIMap

Organization Active NPI

Walgreen Co

  • Pharmacy
  • Potomac, MD
National Provider Identifier
1982891065
Registry record updated Nov 26, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
P06786 Issued in MD
Legal business name
WALGREEN CO
Practice address
10101 River Rd
Potomac, MD 20854-4904
Phone
(301) 983-4890
NPI assigned
Oct 2, 2007
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 26, 2018

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

Authorized official

Name
Alyssa Sweeten
Title
Manager
Phone
(217) 709-2386

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X P06786 MD Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

10101 River Rd
Potomac, MD 20854-4904

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
414268300MedicaidMD
058338100MedicaidDC
2133647OtherNCPDP
414269100OtherMDMEDICAID DME

Other names 1

  • WALGREENS #11123 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

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1191283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1543190400000",
    "number": "1982891065",
    "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": "10101 RIVER RD",
            "city": "POTOMAC",
            "state": "MD",
            "postal_code": "208544904",
            "telephone_number": "301-983-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2007-10-02",
        "last_updated": "2018-11-26",
        "status": "A",
        "authorized_official_last_name": "SWEETEN",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-709-2386"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "MD",
            "license": "P06786",
            "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": "414268300",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "058338100",
            "state": "DC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "2133647",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID DME",
            "identifier": "414269100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #11123",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #11123",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potomac, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2018; 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.