WALGREENS #11389 (WALGREEN CO) NPI 1124297114

Pharmacy in Millbrook, AL

NPI 1124297114 Organization Pharmacy Medicare Supplier Does Not Accept Medicare Approved Payment CLIA Number 01D2222287 CLIA Certificate of Waiver

About WALGREENS #11389 (WALGREEN CO)

Walgreens #11389 (walgreen Co) is a provider established in Millbrook, Alabama specializing in pharmacy. The NPI number of Walgreens #11389 (walgreen Co) is 1124297114 and was assigned on February 2008. The practitioner's primary taxonomy code is 333600000X with license number 113109 (AL). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Walgreens #11389. The authorized official of this NPI record is Mr. Alan T Nielsen (Treasurer)

Walgreens #11389 is a medicare supplier with PTAN 0282936305 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: Oral Antiemetic Drugs or Epoetin or Immunosuppressive Drugs or Infusion Drugs or Oral Anticancer Drugs or Nebulizer Drugs or Blood Glucose Monitors/Supplies (Non-Mail Order).

The CLIA number of Walgreens #11389 is 01D2222287 registered as a "pharmacy" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Walgreens #11389 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

1124297114

Provider NameWALGREENS #11389 (WALGREEN CO)
Provider Location Address3720 HIGHWAY 14 MILLBROOK, AL 36054
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 #11389
Other Name TypeDoing Business As (3)
Enumeration Date02-25-2008
Last Update Date01-11-2016


Primary Taxonomy

Taxonomy Code333600000X
ClassificationPharmacy
TypeSuppliers
License No.113109
License StateAL
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 #11389
3720 HIGHWAY 14
MILLBROOK, AL
ZIP 36054
Phone: (334) 285-1450

Get Directions


Mailing Address

WALGREENS #11389
1901 E VOORHEES ST
MS 790
DANVILLE, IL
ZIP 61834
Phone: (217) 709-2386
Fax: (217) 709-2344



Authorized Official

Authorized Official NameMR. ALAN T NIELSEN
Authorized Official TitleTREASURER
Authorized Official Phone(847) 315-3523

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN0282936305
Accepts Medicare AssignmentNO
Specialities ListPharmacy.
Supplies List
  • Oral Antiemetic Drugs - FDA antiemetic drugs
  • 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 -
  • Oral Anticancer Drugs - FDA anticancer drugs
  • Nebulizer Drugs - Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
  • 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 1124297114 is:

CLIA Number01D2222287
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
0282936305MEDICARE NSC (07)
0135168OTHER (01)
1124297114MEDICAID (05)AL
1124297114 DMEMEDICAID (05)AL
P00400633MEDICARE PIN (08)
PHC049MEDICARE PIN (08)

Other Providers at the same location


The following 5 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1154604320 SASHA MARGO GIFFORD PHARM D
Individual
Pharmacist3720 HIGHWAY 14
MILLBROOK, AL 36054
(334) 285-1450
1841741543 SHAMELIEN DOWDELL
Individual
Pharmacist3720 HIGHWAY 14
MILLBROOK, AL 36054
(334) 285-1450
1679126726DR. KRISTEN WILLIAMSON PHARMD
Individual
Pharmacist3720 HIGHWAY 14
MILLBROOK, AL 36054
(334) 285-1450
1346851342DR. ERIKA BOWENS PHARMD
Individual
Pharmacist3720 HIGHWAY 14
MILLBROOK, AL 36054
(335) 285-1450
1740877505DR. NATHAN PATRICK HOXSIE PHARMD.
Individual
Pharmacist3720 HIGHWAY 14
MILLBROOK, AL 36054
(334) 285-1450

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
The code describing 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.