WALGREENS #09629
NPI 1245255546
Pharmacy in Loganville, GA

Q: What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1245255546. It was assigned to this organization in the NPPES registry on July 13, 2006. The provider is doing business as Walgreens #09629.

Q: What is Walgreen Co's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Q: When was this NPI record last updated?

The NPPES record for Walgreen Co was last updated on July 25, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.

Active since July 13, 2006CLIA 11D2028571 · Waiver

4398 ATLANTA HWY, LOGANVILLE, GA 30052(678) 639-0213(678) 639-1547 Get Directions Write a Review

NPPES record last updated: July 25, 2024. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 25, 2024, Nov 1, 2023, Feb 23, 2022 and 2 more (5 updates tracked since 2015).

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About Walgreens #09629 NPPES

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

WALGREENS #09629 (NPI 1245255546) is a healthcare organization registered as a pharmacy in Loganville, Georgia and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through March 21, 2027 and lists Virginia Garza, Manager, as its authorized official.

NPPES Registry Identity

NPI1245255546

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALGREEN CO

Location Address4398 ATLANTA HWYLoganville, GA 30052-7314

Mailing Address1901 E Voorhees St, Ms# 790Danville, IL 61834-4509 · (217) 709-2364 · Fax (217) 709-2344

Phone(678) 639-0213

Fax(678) 639-1547

Organization SubpartYesParent: Walgreens Boots Alliance Inc

Authorized OfficialVirginia GarzaManager · (217) 709-2364

Enumeration DateJuly 13, 2006

Last NPPES UpdateJuly 25, 20245 updates tracked since enumeration

NPPES CertifiedJuly 25, 2024

✔ NPI 1245255546 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in GA · PHRE009057

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

4398 ATLANTA HWY, Loganville, GA 30052

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Other Names 1

Doing Business AsWalgreens #09629

Other Identifiers 2

Other1154549Ncpdp

Medicaid743074294AGA

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 11D2028571

Walgreens #9629 · Loganville, GA

Active · expires Mar 21, 2027

CLIA Number11D2028571

Laboratory TypePharmacy

Certificate Effective DateMarch 22, 2025

Certificate Expiration DateMarch 21, 2027

Laboratory DirectorOladipo A. Adebisi

Laboratory Phone(678) 639-0213

Laboratory LocationWalgreens #96294398 Atlanta Highway, Loganville, GA 30052

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.

79 services78 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.

48 services48 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.

21 services21 patients

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #9629 carries, from the Medicare DMEPOS supplier directory.

Walgreens #9629

DMEPOS supplier · Loganville, GAOperated by Walgreen Co

✔

Accepts Medicare assignment

Walgreens #9629 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)20354969

Medicare Participant SinceMarch 1, 2022

Supplier Location4398 Atlanta HwyLoganville, GA 30052

Phone(678) 639-0213

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 12

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

SHIRLEY ROSE PELTRO PHARM.D

Pharmacist