WALGREENS #11113 Full NPI Record 1003002254

Pharmacy in Gray, TN

Complete NPI Dataset

The following table represents the complete NPI 1003002254 dataset for Walgreens #11113 in 5104 BOBBY HICKS HWY GRAY, TN 37615. The data table includes a list of all field names, values and definitions of the complete NPI record. The NPI dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1003002254The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. 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 (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameWALGREEN CO.The name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameWALGREENS #11113Other name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other 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 First Line Business Mailing Address1901 E VOORHEES STThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressMS #790The second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameDANVILLEThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameILThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code618344509The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number2177092351The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number2177092344The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address5104 BOBBY HICKS HWYThe first line 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 Business Practice Location Address City NameGRAYThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameTNThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code376156217The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number4234773372The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number4234778533The fax number associated with the location address of the provider being identified.
Provider Enumeration Date9/21/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date4/26/2022The date that a record was last updated or changed.
Authorized Official Last NameTAYLORThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameKIRAThe first name of the authorized official.
Authorized Official Title or PositionMANAGERThe title or position of the authorized official.
Authorized Official Telephone Number2177092351The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 13336C0003XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2332B00000X
Healthcare Provider Primary Taxonomy Switch 2N
Healthcare Provider Taxonomy Code 3333600000X
Provider License Number 34444The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3TNThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3Y
Other Provider Identifier 14440664Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 101Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier Issuer 1NCPDP
Other Provider Identifier 24440664Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 205Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2TN
Is Organization SubpartY
Parent Organization LBNWALGREENS BOOTS ALLIANCE INC
Parent Organization TINUNAVAIL
NPI Certification Date3/30/2022