1669668752 NPI number — WALGREENS SPECIALTY PHARMACY LLC

Table of content: (NPI 1669668752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669668752 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:
Provider Other Organization Name Type Code:
6
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:
1669668752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2021
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:
9775 SW GEMINI DR
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
BEAVERTON
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-202-4014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2007

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: 3336H0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: RP-0002419 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1669668752 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669668752 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3842944 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3842944 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1028445 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1092434 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669668752 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669668752 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 278926 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 457263 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669668752 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 685274-01 , issued by the state of ( HI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100277090 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37104811 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 554205700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669668752 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200135400A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 320618 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44039751 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1669668752 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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