WALGREENS #11113 (WALGREEN CO.) NPI 1003002254

Pharmacy in Gray, TN

Organization Pharmacy Medicare Supplier

About WALGREENS #11113 (WALGREEN CO.)

Walgreens #11113 (walgreen Co.) is a provider established in Gray, Tennessee specializing in pharmacy. The NPI number of Walgreens #11113 (walgreen Co.) is 1003002254 and was 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 4 years ago. The provider's is doing business as Walgreens #11113. The authorized official of this NPI record is Mr. Alan T Nielsen (Treasurer)

The provider accepts Medicare assignment for all durable medical equipment and supplies. Walgreens #11113 carries the following product categories: home blood glucose monitors, test strips, lancets.

NPI

1003002254

Provider NameWALGREENS #11113 (WALGREEN CO.)
Provider Location Address5104 BOBBY HICKS HWY GRAY, TN 37615
Provider Mailing Address1901 E VOORHEES ST MAILSTOP #790 DANVILLE, IL 61834
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?Yes
Other Organization NameWALGREENS #11113
Other Name TypeDoing Business As (3)
Enumeration Date09-21-2007
Last Update Date07-25-2016

Primary Taxonomy

Taxonomy Code333600000X
ClassificationPharmacy
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.

Business Address

WALGREENS #11113
5104 BOBBY HICKS HWY
GRAY, TN
ZIP 37615
Phone: (423) 477-3372

Get Directions

Mailing Address

WALGREENS #11113
1901 E VOORHEES ST
MAILSTOP #790
DANVILLE, IL
ZIP 61834
Phone: (217) 709-2386
Fax: (217) 709-2344

Authorized Official

Authorized Official NameMR. ALAN T NIELSEN
Authorized Official TitleTREASURER
Authorized Official Phone(847) 315-3523

Medicare - Medical Supplier Products

The provider accepts medicare and carries the following medical supplies product categories:

  • Blood Glucose Monitors & Supplies: Non-Mail Order - Home blood glucose monitors, Test strips, Lancets

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
1332B00000XSuppliersDurable Medical Equipment & Medical SuppliesNo

Taxonomy Description: a supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

23336C0003XSuppliersPharmacyCommunity/Retail PharmacyNo

Taxonomy Description: a pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the dispensing process); administer vaccinations; and provide other professional services associated with pharmaceutical care such as health screenings, consultative services with other health care providers, collaborative practice, disease state management, and education classes.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
4440664OTHER (01)
P00400633MEDICARE PIN (08)
4440664MEDICAID (05)TN
0282936022MEDICARE NSC (07)
PHC049MEDICARE PIN (08)

Other Providers at the same location


The following 7 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1053930420DR. MOLLY MARIE KETRON PHARMD
Individual
Pharmacist5104 BOBBY HICKS HWY
JOHNSON CITY, TN 37615
(423) 477-3372
1255642005 LAURA C DINISIO PHARMD
Individual
Pharmacist5104 BOBBY HICKS HWY
GRAY, TN 37615
(423) 477-8533
1265743405DR. WILLIAM CORTNEY YATES PHARM.D.
Individual
Pharmacist5104 BOBBY HICKS HWY
GRAY, TN 37615
(423) 477-3372
1497066609 MANDY DISHNER PHARM.D.
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
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

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.