WALGREENS #04650
NPI 1487669537
Pharmacy in Ruidoso, NM

Active since July 29, 2006CLIA 32D2240824 · Waiver
138 SUDDERTH DR, RUIDOSO, NM 88345(505) 257-1566 Get Directions Write a Review

NPPES record last updated: September 10, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Sep 10, 2024, Apr 12, 2022, Oct 24, 2021 and 2 more (5 updates tracked since 2015).

About Walgreens #04650 NPPES

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

WALGREENS #04650 (NPI 1487669537) is a healthcare organization registered as a pharmacy in Ruidoso, New Mexico and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through October 21, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1487669537
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address138 SUDDERTH DRRuidoso, NM 88345-6025
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (847) 527-2489 · Fax (217) 709-2344
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJuly 29, 2006
Last NPPES UpdateSeptember 10, 20245 updates tracked since enumeration
NPPES CertifiedSeptember 10, 2024
NPI 1487669537 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in NM · PH00004107
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
138 SUDDERTH DR, Ruidoso, NM 88345

Other Names 1

Doing Business AsWalgreens #04650

Other Identifiers 3

Medicaid8530920SD
Medicaid61979NM
Other3209473Other Id Number-commercial Number

Accepted 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 32D2240824

Walgreens #04650 · Ruidoso, NM
Active · expires Oct 21, 2027
CLIA Number32D2240824
Laboratory TypePharmacy
Certificate Effective DateOctober 22, 2025
Certificate Expiration DateOctober 21, 2027
Laboratory DirectorSheri K. Schramm
Laboratory Phone(575) 257-1566
Laboratory LocationWalgreens #04650138 Sudderth Dr, Ruidoso, NM 88345
CLIA data matches this NPI record on: Address Name
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 Walgreens #4650 carries, from the Medicare DMEPOS supplier directory.

Walgreens #4650

DMEPOS supplier · Ruidoso, NMOperated by Walgreen Co

Accepts Medicare assignment

Walgreens #4650 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)20395679
Medicare Participant SinceMarch 1, 2022
Supplier Location138 Sudderth DrRuidoso, NM 88345
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 8

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

Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345
Pharmacist
138 SUDDERTH DR
RUIDOSO, NM 88345

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 1487669537. It was assigned to this organization in the NPPES registry on July 29, 2006. The provider is doing business as Walgreens #04650.

Where is Walgreen Co located?

Walgreen Co is located at 138 Sudderth Dr, Ruidoso, NM 88345. The listed phone number is (505) 257-1566.

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, Walgreens #4650 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 32D2240824) is associated with this NPI, valid through October 21, 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 September 10, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.