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WALGREEN CO
NPI 1689856114
Pharmacy in Portland, TN

Active since November 27, 2007CLIA 44D2032262 · Waiver
104 HIGHWAY 52 W, PORTLAND, TN 37148(615) 325-4058(615) 325-8598 Get Directions Write a Review

NPPES record last updated: October 20, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 1, 2023, Jan 11, 2016 (2 updates tracked since 2016).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1689856114), doing business as Walgreens #11129, is a healthcare organization registered as a pharmacy in Portland, Tennessee and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through March 24, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1689856114
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address104 HIGHWAY 52 WPortland, TN 37148-1406
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Phone(615) 325-4058
Fax(615) 325-8598
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateNovember 27, 2007
Last NPPES UpdateOctober 20, 20252 updates tracked since enumeration
NPPES CertifiedOctober 20, 2025
✔ NPI 1689856114 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in TN · 4458
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
104 HIGHWAY 52 W, Portland, TN 37148
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Other Names 1

Doing Business AsWalgreens #11129

Other Identifiers 2

Medicaid4440842TN
Other4440842Ncpdp

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 44D2032262

Walgreens #11129 · Portland, TN
Active · expires Mar 24, 2027
CLIA Number44D2032262
Laboratory TypePharmacy
Certificate Effective DateMarch 25, 2025
Certificate Expiration DateMarch 24, 2027
Laboratory DirectorWendy L. Gullo
Laboratory Phone(615) 325-4058
Laboratory LocationWalgreens #11129104 Highway 52 West, Portland, TN 37148
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 5

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.
111 services111 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.
67 services67 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.
37 services37 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
15 services15 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
15 services15 patients

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #11129 carries, from the Medicare DMEPOS supplier directory.

Walgreens #11129

DMEPOS supplier · Portland, TNOperated by Walgreen Co
✔

Accepts Medicare assignment

Walgreens #11129 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)20375117
Medicare Participant SinceMarch 1, 2022
Supplier Location104 Highway 52 WPortland, TN 37148
Phone(615) 325-4058
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 4

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

DR. TIMOTHY WAYNE BANDY PHARMD
Pharmacist
104 HIGHWAY 52 W
PORTLAND, TN 37148
Sumner County (615) 325-4058
JENNIFER LYNN HARRIS PHARM.D.
Pharmacist
104 HIGHWAY 52 W
PORTLAND, TN 37148
Sumner County (615) 325-4058
SHEA SULLINS
Pharmacist
104 HIGHWAY 52 W
PORTLAND, TN 37148
Sumner County (615) 325-4058
MATTHEW ESTES
Pharmacist
104 HIGHWAY 52 W
PORTLAND, TN 37148
Sumner County (615) 325-4058

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 1689856114. It was assigned to this organization in the NPPES registry on November 27, 2007.

Where is Walgreen Co located?

Walgreen Co is located at 104 Highway 52 W, Portland, TN 37148. The listed phone number is (615) 325-4058.

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 #11129 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 44D2032262) is associated with this NPI, valid through March 24, 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 42 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 October 20, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.