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WALGREENS #12756
NPI 1457693004
Pharmacy in Moultrie, GA

Active since March 21, 2013CLIA 11D2225011 · Waiver
2025 1ST AVE SE, MOULTRIE, GA 31788(229) 890-2776(229) 985-3025 Get Directions Write a Review

NPPES record last updated: April 6, 2022. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 6, 2022, Dec 21, 2016, Jan 13, 2016 (3 updates tracked since 2016).

About Walgreens #12756 NPPES

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

WALGREENS #12756 (NPI 1457693004) is a healthcare organization registered as a pharmacy in Moultrie, Georgia and active in the NPI registry since March 2013. The organization holds a CLIA Waiver certificate valid through May 17, 2027 and lists Kira Taylor, Manager, as its authorized official.

NPPES Registry Identity

NPI1457693004
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address2025 1ST AVE SEMoultrie, GA 31788-5155
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (217) 709-2351 · Fax (217) 709-2344
Phone(229) 890-2776
Fax(229) 985-3025
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialKira TaylorManager · (217) 709-2351
Enumeration DateMarch 21, 2013
Last NPPES UpdateApril 6, 20223 updates tracked since enumeration
NPPES CertifiedApril 6, 2022
✔ NPI 1457693004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in GA · PHRE009932
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
2025 1ST AVE SE, Moultrie, GA 31788
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Other Names 1

Doing Business AsWalgreens #12756

Other Identifiers 2

Other1163308GA · Ncpdp
Medicaid003137212AGA

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 11D2225011

Walgreens #12756 · Moultrie, GA
Active · expires May 17, 2027
CLIA Number11D2225011
Laboratory TypePharmacy
Certificate Effective DateMay 18, 2025
Certificate Expiration DateMay 17, 2027
Laboratory DirectorKayla Marshall
Laboratory Phone(229) 890-2776
Laboratory LocationWalgreens #127562025 1st Avenue SE, Moultrie, GA 31788
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

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

ALEX LAM
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)
2025 1ST AVE SE
MOULTRIE, GA 31788
Colquitt County (229) 890-2776

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 1457693004. It was assigned to this organization in the NPPES registry on March 21, 2013. The provider is doing business as Walgreens #12756.

Where is Walgreen Co located?

Walgreen Co is located at 2025 1st Ave SE, Moultrie, GA 31788. The listed phone number is (229) 890-2776.

What is Walgreen Co's specialty?

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

Does Walgreen Co hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2225011) is associated with this NPI, valid through May 17, 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 39 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 April 6, 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.