WALGREENS # 11773
NPI 1124291497
Pharmacy in South Boston, VA
NPI Status: Active since April 08, 2008
Contact Information
3220 HALIFAX RD
SOUTH BOSTON, VA
ZIP 24592
Phone: (434) 575-5338
Fax: (434) 575-5976
- Organization
- Pharmacy
- Accepts Insurance
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 49D2052316
- CLIA Cert. Type: Pharmacy
- CLIA Exp. Date: 01-07-2027
About WALGREENS # 11773
This page provides the complete NPI Profile along with additional information for Walgreens # 11773, a provider established in South Boston, Virginia operating as a Pharmacy. The healthcare provider is registered in the NPI registry with number 1124291497 assigned on April 2008. The practitioner's primary taxonomy code is 333600000X with license number 0201004229 (VA). The provider is registered as an organization and their NPI record was last updated 3 years ago. The provider's is doing business as Walgreens # 11773. The authorized official of this NPI record is Kira Taylor (Manager)
- NPI
- 1124291497
- Provider Legal Name
- WALGREEN CO
- Other Organization Name
- WALGREENS # 11773
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 3220 HALIFAX RD SOUTH BOSTON, VA 24592
- Location Phone
- (434) 575-5338
- Location Fax
- (434) 575-5976
- Mailing Address
- 1901 E VOORHEES ST MS #790 DANVILLE, IL 61834
- Mailing Phone
- (217) 709-2351
- Mailing Fax
- (434) 575-5976
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 04-08-2008
- Last Update Date
- 10-30-2023
- Code Navigator
Walgreens # 11773 is a medicare supplier with PTAN 20372741 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.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).
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Pharmacy
- Taxonomy Code
- 333600000X
- Type
- Suppliers
- License No.
- 0201004229
- License State
- VA
- Taxonomy Description
- 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.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies | |
| 2 | 3336C0003X | Suppliers | Pharmacy |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Humana Dental Smart Choice - PPO
- Humana Dental Smart Choice - High - PPO
- Humana Dental Smart Choice - Lite - PPO
- Humana Dental Smart Choice - Low - PPO
- Balance by Medica Bronze $0 Copay PCP Visits - EPO
- Balance by Medica Bronze $0 Copay PCP Visits - PPO
- Balance by Medica Bronze Premier - EPO
- Balance by Medica Bronze Premier - PPO
- Balance by Medica Expanded Bronze Standard - EPO
- Balance by Medica Expanded Bronze Standard - PPO
- Balance by Medica Gold $0 Copay PCP Visits - EPO
- Balance by Medica Gold $0 Copay PCP Visits - PPO
- Balance by Medica Gold Share - EPO
- Balance by Medica Gold Share - PPO
- Balance by Medica Gold Standard - EPO
- Balance by Medica Gold Standard - PPO
- Balance by Medica Silver $0 Copay PCP Visits - EPO
- Balance by Medica Silver $0 Copay PCP Visits - PPO
- Balance by Medica Silver Share - EPO
- Balance by Medica Silver Share - PPO
- Balance by Medica Silver Standard - EPO
- Balance by Medica Silver Standard - PPO
- Elevate by Medica Bronze $0 Copay PCP Visits - EPO
- Elevate by Medica Bronze Premier - EPO
- Moda Health Affinity Bronze 8000 - EPO
- Moda Health Affinity Bronze 9000 - EPO
- Moda Health Affinity Bronze HDHP 7500 - EPO
- Moda Health Affinity Gold 1000 - EPO
- Moda Health Affinity Gold 1500 - EPO
- Moda Health Affinity Gold 250 - EPO
- Moda Health Affinity Silver 3000 - EPO
- Moda Health Affinity Silver 3400 - EPO
- Moda Health Affinity Silver 4500 - EPO
- Moda Health Affinity Silver 6000 - EPO
- Moda Health Oregon Standard Bronze Affinity - EPO
- Moda Health Oregon Standard Gold Affinity - EPO
- Moda Health Oregon Standard Silver Affinity - EPO
- Moda Select Alaska Bronze 6500 - PPO
- Moda Select Alaska Bronze HDHP 5500 - PPO
- Moda Select Alaska Gold 1500 - PPO
- Moda Select Alaska Silver 4500 - PPO
- Moda Select Alaska Standard Bronze - PPO
- Moda Select Alaska Standard Gold - PPO
- Moda Select Alaska Standard Silver - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 0497707 | MEDICAID (05) | NC | |
| 4840814 | OTHER (01) | NCPDP | |
| 1124291497 | MEDICAID (05) | VA |
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Adm sarscov2 100mcg/0.5ml3rd
Adm sarscov2 50mcg/0.25mlbst
Administration of influenza virus vaccine
Administration of pneumococcal vaccine
Fee covid-19 vac 14 res
Influenza vaccine split virus, preservative free
Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage
Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use
Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count
This is the administration of a third dose of a SARS-CoV-2 vaccine, given in a dose of 100 micrograms in 0.5 milliliters. This vaccine helps your body develop immunity against the COVID-19 virus. It's a crucial step in protecting your health.
This service was performed 12 times for 12 patientsThis procedure involves administering a dose of a SARS-CoV-2 vaccine. The specific dosage is 50 micrograms in a 0.25 milliliter booster shot. This vaccine helps your body build immunity against the COVID-19 virus. It's a key part of global efforts to control the pandemic.
This service was performed 120 times for 120 patientsThe 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.
This service was performed 250 times for 247 patientsThe pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
This service was performed 18 times for 18 patientsThe "Fee covid-19 vac 14 res" refers to a charge for a specific service related to the COVID-19 vaccine. This could be for administering the vaccine or related care. It's crucial to get vaccinated to protect against the virus. The fee ensures quality service.
This service was performed 210 times for 209 patientsThe 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.
This service was performed 90 times for 90 patientsThe quadrivalent inactivated influenza vaccine is a shot given to protect against four strains of the flu virus. This 0.5 ml dosage helps your body develop immunity to the virus. It's an important step in preventing flu-related complications.
This service was performed 123 times for 121 patientsThe quadrivalent influenza vaccine is a shot to protect you from four different flu viruses. It's preservative-free and given in a 0.5 ml dose. It helps your body build immunity to the flu, reducing your risk of getting sick.
This service was performed 27 times for 27 patientsThe Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
This service was performed 18 times for 18 patientsThis service provides a FDA-approved COVID-19 test kit for personal use. The test is self-administered and self-collected, meaning you conduct the test yourself. The kit contains all necessary items for one test. Follow the instructions carefully to ensure accurate results.
This service was performed 376 times for 44 patientsMedical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20372741
- Accepts Medicare Assignment
- YES
- Specialities List
- Pharmacy.
- Competitive Bidding
- NO
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
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 this NPI number is:
- CLIA Number
- 49D2052316
- Facility Type
- Pharmacy
- Certificate Effective Date
- January 08, 2025
- Certificate Expiration Date
- January 07, 2027
- Laboratory Director
- KHADIDIATOU J. DIALLO
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Walgreens # 11773 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.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1124291497, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 63. The final step is to find the difference between that total and the next multiple of ten (70 - 63 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 63 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 5 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124291497, enumerated as an "organization" on April 08, 2008.
The provider is located at 3220 HALIFAX RD SOUTH BOSTON, VA 24592 and the phone number is (434) 575-5338.
Pharmacy with taxonomy code 333600000X.
The provider might be accepting Accepts: Humana, Medica, Moda Health Plan, Inc., Medicare. Please consult your insurance carrier or call the provider to verify.
