1. Home
  2. Directory
  3. Wisconsin
  4. La Crosse
  5. Pharmacy
  6. NPI Profile

WALGREENS #12455
NPI 1114257706
Pharmacy in La Crosse, WI

Active since January 05, 2010CLIA 52D2209376 · Waiver
3909 MORMON COULEE RD, LA CROSSE, WI 54601(608) 788-9700(608) 788-9706 Get Directions Write a Review

NPPES record last updated: April 1, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Walgreens #12455 NPPES

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

WALGREENS #12455 (NPI 1114257706) is a healthcare organization registered as a pharmacy in La Crosse, Wisconsin and active in the NPI registry since January 2010. The organization holds a CLIA Waiver certificate valid through January 12, 2027 and lists Kira Taylor, Manager, as its authorized official.

NPPES Registry Identity

NPI1114257706
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address3909 MORMON COULEE RDLa Crosse, WI 54601-7965
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (217) 709-2351 · Fax (217) 709-2344
Phone(608) 788-9700
Fax(608) 788-9706
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialKira TaylorManager · (217) 709-2351
Enumeration DateJanuary 5, 2010
Last NPPES UpdateApril 1, 2022
NPPES CertifiedApril 1, 2022
✔ NPI 1114257706 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in WI · 8994-042
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
3909 MORMON COULEE RD, La Crosse, WI 54601
Open in Google Maps ↗

Other Names 1

Doing Business AsWalgreens #12455

Other Identifiers 2

Medicaid1114257706WI
Other5132080WI · 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 52D2209376

Walgreens #12455 · La Crosse, WI
Active · expires Jan 12, 2027
CLIA Number52D2209376
Laboratory TypePharmacy
Certificate Effective DateJanuary 13, 2025
Certificate Expiration DateJanuary 12, 2027
Laboratory DirectorKaran V. Shah
Laboratory Phone(608) 788-9700
Laboratory LocationWalgreens #124553909 Mormon Coulee Rd, La Crosse, WI 54601
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
329 services328 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
209 services209 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
107 services107 patients

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 · La Crosse, WI
✔

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)20378303
Medicare Participant SinceMarch 1, 2022
Supplier Location3909 Mormon Coulee RdLa Crosse, WI 54601
Phone(608) 788-9700
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 6

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

DR. JOSHUA P VAN VELDHUIZEN PHARM.D.; RPH
Pharmacist
3909 MORMON COULEE RD
LA CROSSE, WI 54601
La Crosse County (608) 788-9700
MEGAN BORRIES
Pharmacist
3909 MORMON COULEE RD
LA CROSSE, WI 54601
La Crosse County (608) 788-9700
MRS. LISA LOUISE WALL RPH
Pharmacist
3909 MORMON COULEE RD
LA CROSSE, WI 54601
La Crosse County (608) 788-9700
KARAN SHAH
Pharmacist
3909 MORMON COULEE RD
LA CROSSE, WI 54601
La Crosse County (608) 788-9700
MAY YE YANG PHARMD
Pharmacist
3909 MORMON COULEE RD
LA CROSSE, WI 54601
La Crosse County (608) 788-9700
DR. ADAM ZART PHARMD
Pharmacist
3909 MORMON COULEE RD
LA CROSSE, WI 54601
La Crosse County (608) 788-9700

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 1114257706. It was assigned to this organization in the NPPES registry on January 5, 2010. The provider is doing business as Walgreens #12455.

Where is Walgreen Co located?

Walgreen Co is located at 3909 Mormon Coulee Rd, La Crosse, WI 54601. The listed phone number is (608) 788-9700.

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 52D2209376) is associated with this NPI, valid through January 12, 2027. 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 42 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 April 1, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.