ALLIANCERX WALGREENS PRIME #12314 (WALGREENS SPECIALTY PHARMACY LLC) NPI 1669668752
Pharmacy in Beaverton, OR
About ALLIANCERX WALGREENS PRIME #12314 (WALGREENS SPECIALTY PHARMACY LLC)
Alliancerx Walgreens Prime #12314 (walgreens Specialty Pharmacy Llc) is a provider established in Beaverton, Oregon specializing in pharmacy. The NPI number of Alliancerx Walgreens Prime #12314 (walgreens Specialty Pharmacy Llc) is 1669668752 and was assigned on September 2007. The practitioner's primary taxonomy code is 333600000X with license number RP-0002419 (OR). The provider is registered as an organization and their NPI record was last updated one year ago. The provider's is doing business as Alliancerx Walgreens Prime #12314. The authorized official of this NPI record is Kira Taylor (Manager)
| NPI | 1669668752 |
| Provider Name | ALLIANCERX WALGREENS PRIME #12314 (WALGREENS SPECIALTY PHARMACY LLC) |
| Provider Location Address | 9775 SW GEMINI DR STE 1 BEAVERTON, OR 97008 |
| Provider Mailing Address | 1901 E VOORHEES ST MS 790 DANVILLE, IL 61834 |
| NPI Entity Type | Organization |
| Is Sole Proprietor? | N/A |
| Is Organization Subpart? | Yes |
| Other Organization Name | ALLIANCERX WALGREENS PRIME #12314 |
| Other Name Type | Doing Business As (3) |
| Enumeration Date | 09-21-2007 |
| Last Update Date | 05-11-2021 |
Primary Taxonomy
| Taxonomy Code | 333600000X |
| Classification | Pharmacy |
| Type | Suppliers |
| License No. | RP-0002419 |
| License State | OR |
| Taxonomy Description | 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. |
Business Address
ALLIANCERX WALGREENS PRIME #12314
9775 SW GEMINI DR
STE 1
BEAVERTON, OR
ZIP 97008
Phone: (866) 202-4014
Mailing Address
ALLIANCERX WALGREENS PRIME #12314
1901 E VOORHEES ST
MS 790
DANVILLE, IL
ZIP 61834
Phone: (217) 709-2386
Fax: (217) 709-2344
Secondary Taxonomies
The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.
| No. | Taxonomy Code | Type | Classification | Specialization | License No. | State | Primary |
|---|---|---|---|---|---|---|---|
| 1 | 3336H0001X | Suppliers | Pharmacy | Home Infusion Therapy Pharmacy | No | ||
Taxonomy Description: pharmacy-based, decentralized patient care organization with expertise in USP 797-compliant sterile drug compounding that provides care to patients with acute or chronic conditions generally pertaining to parenteral administration of drugs, biologics and nutritional formulae administered through catheters and/or needles in home and alternate sites. Extensive professional pharmacy services, care coordination, infusion nursing services, supplies and equipment are provided to optimize efficacy and compliance. | |||||||
| 2 | 3336S0011X | Suppliers | Pharmacy | Specialty Pharmacy | No | ||
Taxonomy Description: a pharmacy that dispenses generally low volume and high cost medicinal preparations to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration. | |||||||
Additional Identifiers
Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State |
|---|---|---|
| 1669668752 | MEDICAID (05) | ID |
| 320618 | MEDICAID (05) | AZ |
| 3842944 | OTHER (01) | |
| 0216467 | MEDICAID (05) | OH |
| 1669668752 | MEDICAID (05) | UT |
| 1669668752 | MEDICAID (05) | MT |
| 1669668752 | MEDICAID (05) | IA |
| 3842944 | MEDICAID (05) | TN |
| 1092434 | MEDICAID (05) | WA |
| 1669668752 | MEDICAID (05) | VA |
| 200135400A | MEDICAID (05) | OK |
| 37104811 | MEDICAID (05) | NM |
| 44039751 | MEDICAID (05) | CO |
| 457263 | MEDICAID (05) | ND |
| 1028445 | MEDICAID (05) | AK |
| 200923000A | MEDICAID (05) | IN |
| 278926 | MEDICAID (05) | OR |
| 554205700 | MEDICAID (05) | MD |
| 1669668752 | MEDICAID (05) | MI |
| 1021135430001 | MEDICAID (05) | PA |
| 1669668752 | MEDICAID (05) | MN |
| 7100277090 | MEDICAID (05) | KY |
| 200333400E | MEDICAID (05) | KS |
| 7R2419 | MEDICAID (05) | SC |
| 685274-01 | MEDICAID (05) | HI |
Other Providers at the same location
The following 11 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1346660990 | MR. CLAY PARKEL RPH Individual | Pharmacist | 9775 SW GEMINI DR BEAVERTON, OR 97008 (866) 202-4015 |
| 1275953879 | ALAN KANNING RPH Individual | Pharmacist | 9775 SW GEMINI DR BEAVERTON, OR 97008 (866) 202-4015 |
| 1235559881 | MR. BRAD CRAIG BOEHME Individual | Pharmacist | 9775 SW GEMINI DR STE 1 BEAVERTON, OR 97008 (866) 202-4014 |
| 1538589809 | ELIZABETH ASAI Individual | Pharmacist | 9775 SW GEMINI DR BEAVERTON, OR 97008 (866) 202-4015 |
| 1164842597 | SANDRA SCOTT Individual | Pharmacist | 9775 SW GEMINI DR BEAVERTON, OR 97008 (866) 202-4014 |
| 1053721084 | SHARON OKABAYASHI BRANHAM Individual | Pharmacist | 9775 SW GEMINI DR BEAVERTON, OR 97008 (866) 202-4014 |
| 1588074520 | SHERYL BLODGETT PHARMD Individual | Pharmacist | 9775 SW GEMINI DR SUITE 1 BEAVERTON, OR 97008 (866) 202-4014 |
| 1720498371 | DR. NICOLE JEANE O'KANE PHARM.D. Individual | Pharmacist | 9775 SW GEMINI DR STE 1 BEAVERTON, OR 97008 (866) 202-4014 |
| 1790196509 | CHRIS FUEGY Individual | Pharmacist | 9775 SW GEMINI DR BEAVERTON, OR 97008 (866) 202-4014 |
| 1386897338 | THERESA JAMES PHARMD Individual | Pharmacist | 9775 SW GEMINI DR SUITE 1 BEAVERTON, OR 97008 (503) 520-6913 |
| 1477786788 | MRS. TRACY L FENTRESS R.PH. Individual | Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist) | 9775 SW GEMINI DR BEAVERTON, OR 97008 (888) 202-4014 |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.