WALGREENS #11113
NPI 1003002254
Pharmacy in Gray, TN

NPI Status: Active since September 21, 2007

Contact Information

5104 BOBBY HICKS HWY
GRAY, TN
ZIP 37615
Phone: (423) 477-3372
Fax: (423) 477-8533

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  • Organization
  • Pharmacy
  • CLIA Number 44D1086038
  • CLIA Certificate of Waiver

About WALGREENS #11113

Walgreens #11113 is a provider established in Gray, Tennessee operating as a Pharmacy. The healthcare provider is registered in the NPI registry with number 1003002254 assigned on September 2007. The practitioner's primary taxonomy code is 333600000X with license number 4444 (TN). The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's is doing business as Walgreens #11113. The authorized official of this NPI record is Kira Taylor (Manager)

NPI1003002254
Provider Legal NameWALGREEN CO.
Other Organization NameWALGREENS #11113
Other Name TypeDoing Business As (3)
Location Address5104 BOBBY HICKS HWY GRAY, TN 37615
Location Phone(423) 477-3372
Mailing Address1901 E VOORHEES ST MS #790 DANVILLE, IL 61834
Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Enumeration Date09-21-2007
Last Update Date04-26-2022
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The CLIA number of Walgreens #11113 is 44D1086038 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Walgreens #11113 to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

Location Map

Mailing Address

1901 E VOORHEES ST
MS #790
DANVILLE, IL
ZIP 61834
Phone: (217) 709-2351
Fax: (217) 709-2344

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Pharmacy

Taxonomy Code333600000X
TypeSuppliers
License No.4444
License StateTN
Taxonomy DescriptionA facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is located.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)
1332B00000XSuppliers

Durable Medical Equipment & Medical Supplies

 
23336C0003XSuppliers

Pharmacy
Community/Retail Pharmacy

 

Insurance Plans Accepted

The NPI profile data suggests this provider may be accepting health plans from these insurance companies or healthcare programs:

  • Medicaid
  • Medicare

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

KIRA TAYLOR

Authorized Official TitleMANAGER
Authorized Official Phone(217) 709-2351

Additional Identifiers

The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State Identifier Issuer
4440664OTHER (01)NCPDP
4440664MEDICAID (05)TN 

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number44D1086038
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

Reviews for WALGREENS #11113

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1003002254
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2003004210
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 0 + 0 + 3 + 0 + 0 + 4 + 2 + 1 + 0 + 24 = 36
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
40 - 36 = 44

The NPI number 1003002254 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1497066609 MANDY DISHNER PHARM.D.
Individual
Pharmacist5104 BOBBY HICKS HWY
GRAY, TN 37615
(423) 477-3372
1528379252 BILLIE REILLY PHARM.D.
Individual
Pharmacist5104 BOBBY HICKS HWY
GRAY, TN 37615
(423) 477-3372
1770923443 ABIGAIL BROWN PHARMD
Individual
Pharmacist5104 BOBBY HICKS HWY
GRAY, TN 37615
(423) 477-3372
1518307917 ARISSA BROOKE VAUGHN PHARMD
Individual
Pharmacist5104 BOBBY HICKS HWY
GRAY, TN 37615
(423) 477-3372
1053930420DR. MOLLY MARIE KETRON PHARMD
Individual
Pharmacist5104 BOBBY HICKS HWY
JOHNSON CITY, TN 37615
(423) 477-3372

Frequently Asked Questions

What is WALGREENS #11113 NPI number?

The NPI number assigned to this healthcare provider is 1003002254, enumerated in the NPI registry as an "organization" on September 21, 2007

Where is the provider located?

The provider is located at 5104 Bobby Hicks Hwy Gray, Tn 37615 and the phone number is (423) 477-3372

What is the provider specialty code?

This medical organization specializes in Pharmacy with taxonomy code 333600000X

What insurance does WALGREENS #11113 accept?

The provider might be accepting Medicaid and Medicare. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

What is WALGREENS #11113 CLIA number?

The provider's CLIA number is 44D1086038 for a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

How do I update my NPI information?

This NPI record was last updated on September 21, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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