WALGREENS #05396
NPI 1245246719
Pharmacy in Southaven, MS

Active since August 01, 2006CLIA Certified · 2 labs
1011 GOODMAN RD E, SOUTHAVEN, MS 38671(662) 349-6787 Get Directions Write a Review

NPPES record last updated: April 26, 2022. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Apr 26, 2022, Feb 11, 2019, Mar 16, 2017 and 1 more (4 updates tracked since 2015).

About Walgreens #05396 NPPES

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

WALGREENS #05396 (NPI 1245246719) is a healthcare organization registered as a pharmacy in Southaven, Mississippi and active in the NPI registry since August 2006. The organization holds 2 active CLIA laboratory certificates and lists Kira L Taylor, Manager, as its authorized official.

NPPES Registry Identity

NPI1245246719
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address1011 GOODMAN RD ESouthaven, MS 38671-9505
Mailing Address1901 E Voorhees St, Mail Stop 790Danville, IL 61834-4509 · (217) 709-2351 · Fax (217) 709-2344
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialKira L TaylorManager · (217) 709-2351
Enumeration DateAugust 1, 2006
Last NPPES UpdateApril 26, 20224 updates tracked since enumeration
NPPES CertifiedApril 26, 2022
NPI 1245246719 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in MS · 0232001WS
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
1011 GOODMAN RD E, Southaven, MS 38671

Other Names 1

Doing Business AsWalgreens #05396

Other Identifiers 2

Other2517122Other Id Number-commercial Number
Medicaid00330009MS

Accepted Insurance

CLIA Laboratory Certificates CMS CLIA 2

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 25D2035644

Walgreens #05396 · Southaven, MS
Active · expires Nov 8, 2027
CLIA Number25D2035644
Laboratory TypePharmacy
Certificate Effective DateNovember 9, 2025
Certificate Expiration DateNovember 8, 2027
Laboratory DirectorMusa J. Ceesay
Laboratory Phone(662) 349-6787
Laboratory LocationWalgreens #053961011 Goodman Rd E, Southaven, MS 38671
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 25D2035642

Walgreens #04455 · Southaven, MS
Active · expires Mar 30, 2027
CLIA Number25D2035642
Laboratory TypePharmacy
Certificate Effective DateMarch 31, 2025
Certificate Expiration DateMarch 30, 2027
Laboratory DirectorAmanda B. Stevens
Laboratory Phone(601) 342-2906
Laboratory LocationWalgreens #0445535 Stateline Rd W, Southaven, MS 38671
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

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.

Administration of influenza virus vaccine

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.

This service was performed 159 times for 158 patients

Administration of pneumococcal vaccine

The 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 22 times for 22 patients

Influenza vaccine split virus, preservative free

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.

This service was performed 107 times for 107 patients

Influenza vaccine, inactivated

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.

This service was performed 40 times for 40 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use

The 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 22 times for 22 patients

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20363243
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

Other Providers at the Same Location


The following 2 providers are registered at the same or a nearby location.

Pharmacist (Pharmacotherapy)
1011 GOODMAN RD E
SOUTHAVEN, MS 38671
Pharmacist
1011 GOODMAN RD E
SOUTHAVEN, MS 38671

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1245246719, enumerated as an "organization" on August 01, 2006.

The provider is located at 1011 GOODMAN RD E SOUTHAVEN, MS 38671 and the phone number is (662) 349-6787.

Pharmacy with taxonomy code 333600000X.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Absolute. Please consult your insurance carrier or call the provider to verify.