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WALGREENS SPECIALTY PHARMACY #21191
NPI 1063905552
Pharmacy in Charleston, SC

Active since June 11, 2018CLIA 42D2256152 · Waiver
200 RUTLEDGE AVE, CHARLESTON, SC 29403(843) 779-3690(843) 779-3691 Get Directions Write a Review

NPPES record last updated: December 5, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Dec 5, 2024, Aug 14, 2019, Jun 15, 2018 (3 updates tracked since 2018).

About Walgreens Specialty Pharmacy #21191 NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALGREENS SPECIALTY PHARMACY #21191 (NPI 1063905552) is a healthcare organization registered as a pharmacy in Charleston, South Carolina and active in the NPI registry since June 2018. The organization holds a CLIA Waiver certificate valid through March 21, 2028 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1063905552
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address200 RUTLEDGE AVECharleston, SC 29403-5848
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (847) 527-2489 · Fax (217) 709-2344
Phone(843) 779-3690
Fax(843) 779-3691
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJune 11, 2018
Last NPPES UpdateDecember 5, 20243 updates tracked since enumeration
NPPES CertifiedDecember 5, 2024
✔ NPI 1063905552 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
Definition
A 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.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
200 RUTLEDGE AVE, Charleston, SC 29403
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Other Names 1

Doing Business AsWalgreens Specialty Pharmacy #21191

Other Identifiers 1

Other4235710SC · Ncpdp

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 42D2256152

Walgreens #21191 · Charleston, SC
Active · expires Mar 21, 2028
CLIA Number42D2256152
Laboratory TypePharmacy
Certificate Effective DateMarch 22, 2026
Certificate Expiration DateMarch 21, 2028
Laboratory DirectorPiper Mcpherson
Laboratory Phone(843) 779-3690
Laboratory LocationWalgreens #21191200 Rutledge Avenue, Charleston, SC 29403
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreen Co carries, from the Medicare DMEPOS supplier directory.

Walgreen Co

DMEPOS supplier · Charleston, SC
✔

Accepts Medicare assignment

Walgreen Co agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20377151
Medicare Participant SinceMarch 1, 2022
Supplier Location200 Rutledge AveCharleston, SC 29403
Phone(843) 779-3690
Supplier Specialties
Pharmacy

Medicare Product Categories

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
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELIZABETH SPARKS
Pharmacist
200 RUTLEDGE AVE
CHARLESTON, SC 29403
Charleston County (843) 779-3690
DR. ARMSTEAD BERT PRUITT JR. MD
Obstetrics & Gynecology (Gynecology)
200 RUTLEDGE AVE
CHARLESTON, SC 29403
Charleston County (843) 722-8472
PIPER LAURANNE GEHLE PHARM D
Pharmacist
200 RUTLEDGE AVE
CHARLESTON, SC 29403
Charleston County (843) 779-3690
PLANNED PARENTHOOD SOUTH ATLANTIC
Clinic/Center (Family Planning, Non-Surgical)
200 RUTLEDGE AVE
CHARLESTON, SC 29403
Charleston County (843) 628-4380

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1063905552. It was assigned to this organization in the NPPES registry on June 11, 2018. The provider is doing business as Walgreens Specialty Pharmacy #21191.

Where is Walgreen Co located?

Walgreen Co is located at 200 Rutledge Ave, Charleston, SC 29403. The listed phone number is (843) 779-3690.

What is Walgreen Co's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Walgreen Co accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Walgreen Co accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Walgreen Co hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 42D2256152) is associated with this NPI, valid through March 21, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Walgreen Co accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 38 other insurers list Walgreen Co as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Walgreen Co was last updated on December 5, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 20 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.