WALGREENS #11113 (WALGREEN CO.) NPI 1003002254

Pharmacy in Gray, TN

NPI 1003002254 Organization Pharmacy Medicare Supplier Does Not Accept Medicare Approved Payment CLIA Number 44D1086038 CLIA Certificate of Waiver

NPI Profile for 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 April 2022. The provider's is doing business as Walgreens #11113. The authorized official of this NPI record is Kira Taylor (Manager)

Walgreens #11113 is a medicare supplier with PTAN 0282936022 who does not accept Medicare assignment for all durable medical equipment and supplies. The provider may not accept the Medicare allowable as payment in full and may collect additional payment directly from the patient, and/or charge more than the Medicare allowable.The supplier carries the following product categories: Epoetin or Immunosuppressive Drugs or Infusion Drugs or Nebulizer Drugs or Oral Anticancer Drugs or Oral Antiemetic Drugs or Blood Glucose Monitors/Supplies (Non-Mail Order).

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.

NPI

1003002254

Provider NameWALGREENS #11113 (WALGREEN CO.)
Provider Location Address5104 BOBBY HICKS HWY GRAY, TN 37615
Provider Mailing Address1901 E VOORHEES ST MS #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 Date04-26-2022


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
Fax: (423) 477-8533

Get Directions


Mailing Address

WALGREENS #11113
1901 E VOORHEES ST
MS #790
DANVILLE, IL
ZIP 61834
Phone: (217) 709-2351
Fax: (217) 709-2344



Authorized Official

Authorized Official Name KIRA TAYLOR
Authorized Official TitleMANAGER
Authorized Official Phone(217) 709-2351

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN0282936022
Accepts Medicare AssignmentNO
Specialities ListPharmacy.
Supplies List
  • Epoetin - Epoetin is a man-made version of human erythropoietin (EPO)
  • Immunosuppressive Drugs - Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
  • Infusion Drugs -
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
Competitive BiddingNO

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 the NPI number 1003002254 is:

CLIA Number44D1086038
Facility TypePHARMACY
Certificate TypeCertificate of Waiver

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 Identifier Issuer
4440664OTHER (01)NCPDP
4440664MEDICAID (05)TN

NPI Validation Check Digit Calculation


The following table explains step by step the 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

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
Walgreens #11113 is registered as an entity type code: 2. The entity type code describes 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.