WALGREENS #21373
NPI 1366028995
Pharmacy - Mail Order Pharmacy in Northlake, TX

NPI Status: Active since March 23, 2021

Contact Information

4100 DALE EARNHARDT WAY STE 200
NORTHLAKE, TX
ZIP 76262
Phone: (817) 859-1400

NPI Profile Information
Primary Taxonomy
Secondary Taxonomies
Insurance Plans Accepted
Authorized Official
CLIA Information
NPI Validation
Other Providers Same Location
Frequently Asked Questions

Organization
Pharmacy
Mail Order Pharmacy
Accepts Insurance
CLIA Number: 45D2055858
CLIA Cert. Type: Pharmacy
CLIA Exp. Date: 08-03-2027

About WALGREENS #21373

This page provides the complete NPI Profile along with additional information for Walgreens #21373, a provider established in Northlake, Texas operating as a Pharmacy, focusing in mail order pharmacy . The healthcare provider is registered in the NPI registry with number 1366028995 assigned on March 2021. The practitioner's primary taxonomy code is 3336M0002X. 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 #21373. The authorized official of this NPI record is Kira Taylor (Manager)

NPI: 1366028995
Provider Legal Name: WALGREEN CO
Other Organization Name: WALGREENS #21373
Other Name Type: Doing Business As (3)
Entity Type: Organization
Location Address: 4100 DALE EARNHARDT WAY STE 200 NORTHLAKE, TX 76262
Location Phone: (817) 859-1400
Mailing Address: 1901 E VOORHEES ST MS 790 DANVILLE, IL 61834
Mailing Phone: (217) 709-2351
Mailing Fax
Is Sole Proprietor?: No
Is Organization Subpart?: Yes
Enumeration Date: 03-23-2021
Last Update Date: 10-05-2023
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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 Mail Order Pharmacy
Taxonomy Code: 3336M0002X
Type: Suppliers
Taxonomy Description: A pharmacy where pharmacists compound or dispense prescriptions or other medications in accordance with federal and state law, using common carriers to deliver the medications to patient or their caregivers. Mail order pharmacies counsel patients and caregivers (sometimes independent of the dispensing process) through telephone or email contact and provide other professional services associated with pharmaceutical care appropriate to the setting. Mail order pharmacies are licensed as a Mail Order Pharmacy in the state where they are located and may also be licensed or registered as nonresident pharmacies in other states.

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	333600000X	Suppliers	Pharmacy

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

Antidote Health Plan of Arizona, Inc.

Bronze Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Bronze Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Bronze Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Bronze Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Bronze Standard - HMO
Catastrophic Standard - HMO
Gold Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Gold Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Gold Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Gold Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Gold Standard - HMO
Silver Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Silver Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Silver Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Silver Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Silver Standard - HMO

Antidote Health Plan of Ohio, Inc.

Bronze Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Bronze Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Bronze Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Bronze Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Bronze Standard - HMO
Gold Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Gold Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Gold Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Gold Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Gold Standard - HMO
Silver Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Silver Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx - HMO
Silver Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Silver Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx - HMO
Silver Standard - HMO

Avera Health Plans

ConnectPlus $0 Gold - PPO
ConnectPlus $0 Silver - PPO
ConnectPlus $10,600 HSA Eligible HDHP - PPO
ConnectPlus $1800 - PPO
ConnectPlus $4500 - PPO
ConnectPlus $6500 HSA Eligible HDHP - PPO
ConnectPlus $7500 HSA Eligible HDHP - PPO
ConnectPlus MyWeighForward $2000 - PPO
ConnectPlus MyWeighForward $6000 - PPO
ConnectPlus Standard $2000 - PPO
ConnectPlus Standard $6000 - PPO
ConnectPlus Standard $7500 HSA Eligible HDHP - PPO
DirectConnect $0 Gold - HMO
DirectConnect $0 Silver - HMO
DirectConnect $1800 - HMO
DirectConnect $4500 - HMO
DirectConnect $6500 HSA Eligible HDHP - HMO
DirectConnect $7500 HSA Eligible HDHP - HMO
DirectConnect MyWeighForward $2000 - HMO
DirectConnect MyWeighForward $6000 - HMO

Baylor Scott and White Health Plan

BSW Diabetes Care Gold HMO 014 - HMO
BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
BSW Elite Gold HMO 004 - HMO
BSW Elite Gold HMO 012 - HMO
BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
BSW Prime Silver HMO 008 - HMO
BSW Prime Silver HMO 005 - HMO
BSW Savers Bronze HMO H S A 006 - HMO
BSW Savers Bronze HMO H S A 007 (CMS Standardized Plan with $0 Pediatric PCP copay) - HMO
BSW Savers Bronze HMO H S A 009 - HMO

Blue Cross and Blue Shield of Kansas City

Blue KC Catastrophic BlueSelect EPO - EPO
Blue KC Choice Bronze 2 with Spira Care BlueSelect EPO - EPO
Blue KC Choice Silver 1 with Spira Care BlueSelect EPO - EPO
Blue KC Community Silver Preferred-Care Blue EPO - EPO
Blue KC First Bronze Preferred-Care Blue EPO - EPO
Blue KC Simply Blue Bronze with Spira Care Blue Metro EPO - EPO
Blue KC Simply Blue Gold with Spira Care Blue Metro EPO - EPO
Blue KC Simply Blue Silver with Spira Care Blue Metro EPO - EPO
Blue KC Standard Bronze BlueSelect EPO - EPO
Blue KC Standard Bronze Preferred-Care Blue EPO - EPO
Blue KC Standard Gold BlueSelect EPO - EPO
Blue KC Standard Gold Preferred-Care Blue EPO - EPO
Blue KC Standard Silver BlueSelect EPO - EPO
Blue KC Standard Silver Preferred-Care Blue EPO - EPO

Humana

Humana Dental Smart Choice - PPO
Humana Dental Smart Choice - High - PPO
Humana Dental Smart Choice - Lite - PPO
Humana Dental Smart Choice - Low - PPO

Medica

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
Harmony by Medica Bronze $0 Copay PCP Visits - PPO
Harmony by Medica Bronze $0 Copay PCP Visits + Adult Eye Exam - PPO

Moda Health Plan, Inc.

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

Providence Health Plan

Connect 1500 Gold - EPO
Connect 6000 Silver - EPO
Connect 9800 Bronze - EPO
HSA Qualified 7500 Bronze - Choice Network - EPO
HSA-E Qualified 7500 Bronze - Signature Network - EPO
Providence Oregon Standard Bronze Plan - Choice Network - EPO
Providence Oregon Standard Bronze Plan - Signature Network - EPO
Providence Oregon Standard Gold Plan - Choice Network - EPO
Providence Oregon Standard Gold Plan - Signature Network - EPO
Providence Oregon Standard Silver Plan - Choice Network - EPO
Providence Oregon Standard Silver Plan - Signature Network - EPO

UnitedHealthcare

UHC Bronze Copay Focus $0 Indiv Med Ded - HMO
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care) - HMO
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - EPO
UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
UHC Bronze Copay Focus (No Referrals) - HMO
UHC Bronze Copay Focus (Virtual Urgent Care, No Referrals) - EPO
UHC Bronze Copay Focus + (Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision) - HMO
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - EPO
UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
UHC Bronze Copay Focus+ $0 Indiv Med Ded (Dental + Vision) - HMO
UHC Bronze Essential - HMO
UHC Bronze Essential- - HMO
UHC Bronze Essential ($0 Virtual Urgent Care) - HMO
UHC Bronze Essential- ($0 Virtual Urgent Care) - HMO
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals - HMO
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - EPO
UHC Bronze Essential ($0 Virtual Urgent Care, No Referrals) - HMO
UHC Bronze Essential (No Referrals) - EPO
UHC Bronze Essential (No Referrals) - HMO

Medicare

Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.

Medicaid

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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name: KIRA TAYLOR
Authorized Official Title: MANAGER
Authorized Official Phone: (217) 709-2351

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
5933684	OTHER (01)	TX	NCPDP

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: 45D2055858
Facility Type: Pharmacy
Certificate Effective Date: August 04, 2025
Certificate Expiration Date: August 03, 2027
Laboratory Director: THOMAS R. OBRZUT
Certificate Type: Certificate of Waiver
Certificate Type Description: This CLIA certificate is issued to Walgreens #21373 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 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 1366028995, we treat the final digit (5) 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 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).

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.

Pos 1

Doubled → 2

Pos 2

Unchanged

Pos 3

Doubled → 12 → 1 + 2

Pos 4

Unchanged

Pos 5

Doubled → 0

Pos 6

Unchanged

Pos 7

Doubled → 16 → 1 + 6

Pos 8

Unchanged

Pos 9

Doubled → 18 → 1 + 8

Check

Target digit

Regular digit Doubled digit Check digit

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.

1 → 2 6 → 12 → 3 0 → 0 8 → 16 → 7 9 → 18 → 9

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 3 + 1 + 2 + 6 + 0 + 2 + 1 + 6 + 9 + 1 + 8 + 24 = 65

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 65 is 70. The difference is the calculated check digit.

70 - 65 = 5

This NPI is valid

The calculated check digit is 5, which matches the last digit of 1366028995.