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WALGREENS #17030
NPI 1164945374
Pharmacy in Vicksburg, MS

Active since July 19, 2017CLIA 25D2230896 · Waiver
2310 CLAY ST, VICKSBURG, MS 39183(601) 661-5856(601) 661-0645 Get Directions Write a Review

NPPES record last updated: May 9, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 9, 2022, Jun 27, 2018, Jul 19, 2017 (3 updates tracked since 2017).

About Walgreens #17030 NPPES

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

WALGREENS #17030 (NPI 1164945374) is a healthcare organization registered as a pharmacy in Vicksburg, Mississippi and active in the NPI registry since July 2017. The organization holds a CLIA Waiver certificate valid through July 27, 2027 and lists Kira Taylor, Manager, as its authorized official.

NPPES Registry Identity

NPI1164945374
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address2310 CLAY STVicksburg, MS 39183
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (217) 709-2351 · Fax (217) 709-2344
Phone(601) 661-5856
Fax(601) 661-0645
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialKira TaylorManager · (217) 709-2351
Enumeration DateJuly 19, 2017
Last NPPES UpdateMay 9, 20223 updates tracked since enumeration
NPPES CertifiedMay 9, 2022
✔ NPI 1164945374 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
2310 CLAY ST, Vicksburg, MS 39183
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Other Names 1

Doing Business AsWalgreens #17030

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 25D2230896

Walgreens #17030 · Vicksburg, MS
Active · expires Jul 27, 2027
CLIA Number25D2230896
Laboratory TypePharmacy
Certificate Effective DateJuly 28, 2025
Certificate Expiration DateJuly 27, 2027
Laboratory DirectorBrent W. Greer
Laboratory Phone(601) 661-5856
Laboratory LocationWalgreens #170302310 Clay St, Vicksburg, MS 39180
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 · Vicksburg, MS
✔

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)20401703
Medicare Participant SinceMarch 1, 2022
Supplier Location2310 Clay St Walgreens #17030Vicksburg, MS 39183
Phone(601) 661-5856
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.

LOGAN KELLEY PHARM. D
Pharmacist
2310 CLAY ST
VICKSBURG, MS 39183
Warren County (601) 661-5856
JONATHAN FULTON PHARM. D.
Pharmacist
2310 CLAY ST
VICKSBURG, MS 39183
Warren County (601) 661-5856
DR. MICHELYN PATTON PHARMD
Pharmacist
2310 CLAY ST
VICKSBURG, MS 39183
Warren County (601) 661-5856
ZALAK MUKESH PATEL PHARMD
Pharmacist
2310 CLAY ST
VICKSBURG, MS 39183
Warren County (601) 661-5856

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 1164945374. It was assigned to this organization in the NPPES registry on July 19, 2017. The provider is doing business as Walgreens #17030.

Where is Walgreen Co located?

Walgreen Co is located at 2310 Clay St, Vicksburg, MS 39183. The listed phone number is (601) 661-5856.

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 25D2230896) is associated with this NPI, valid through July 27, 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 44 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 May 9, 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.