1942303110 NPI number — WALGREENS SPECIALTY PHARMACY LLC

Table of content: (NPI 1942303110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942303110 NPI number — WALGREENS SPECIALTY PHARMACY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALGREENS SPECIALTY PHARMACY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ALLIANCERX WALGREENS PHARMACY #15438
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942303110
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 E VOORHEES ST
Provider Second Line Business Mailing Address:
MS #790
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61834-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-709-2386
Provider Business Mailing Address Fax Number:
217-709-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41460 HAGGERTY CIR S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-282-5166
Provider Business Practice Location Address Fax Number:
888-570-4700
Provider Enumeration Date:
09/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
KIRA
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
217-709-2351

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 5301007754 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 5301007754 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1942303110 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023139 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942303110 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 551206900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100066062 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942303110 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201052500A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9000182454 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0213639 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942303110 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 19638280007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200333400D , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2008032 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0216482 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 118687600 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942303110 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2348046 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2348046 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003788101 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1942303110 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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