WALGREENS #17697
NPI 1750804589
Pharmacy in East Ellijay, GA

Q: What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1750804589. It was assigned to this organization in the NPPES registry on July 24, 2017. The provider is doing business as Walgreens #17697.

Q: What is Walgreen Co's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Walgreen Co was last updated on May 16, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 24, 2017CLIA 11D2229349 · Waiver

192 1ST AVE, EAST ELLIJAY, GA 30540(706) 635-2241(706) 635-2246 Get Directions Write a Review

NPPES record last updated: May 16, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: May 16, 2022, Feb 13, 2020, Apr 30, 2018 and 1 more (4 updates tracked since 2017).

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About Walgreens #17697 NPPES

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

WALGREENS #17697 (NPI 1750804589) is a healthcare organization registered as a pharmacy in East Ellijay, Georgia and active in the NPI registry since July 2017. The organization holds a CLIA Waiver certificate valid through July 11, 2027 and lists Kira Taylor, Manager, as its authorized official.

NPPES Registry Identity

NPI1750804589

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALGREEN CO

Location Address192 1ST AVEEast Ellijay, GA 30540-8101

Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (217) 709-2351 · Fax (217) 709-2344

Phone(706) 635-2241

Fax(706) 635-2246

Organization SubpartYesParent: Walgreens Boots Alliance Inc

Authorized OfficialKira TaylorManager · (217) 709-2351

Enumeration DateJuly 24, 2017

Last NPPES UpdateMay 16, 20224 updates tracked since enumeration

NPPES CertifiedMay 16, 2022

✔ NPI 1750804589 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in GA · PHARE010563

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

192 1ST AVE, East Ellijay, GA 30540

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Other Names 1

Doing Business AsWalgreens #17697

Other Identifiers 2

Medicaid000766466CGA

Other1171228GA · Ncpdp

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 11D2229349

Walgreens #17697 · Ellijay, GA

Active · expires Jul 11, 2027

CLIA Number11D2229349

Laboratory TypePharmacy

Certificate Effective DateJuly 12, 2025

Certificate Expiration DateJuly 11, 2027

Laboratory DirectorJan Dowda

Laboratory Phone(706) 635-2241

Laboratory LocationWalgreens #17697192 1st Avenue, Ellijay, GA 30540

CLIA data matches this NPI record on: Name Phone

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 #17697 carries, from the Medicare DMEPOS supplier directory.

Walgreens #17697

DMEPOS supplier · East Ellijay, GAOperated by Walgreen Co

✔

Accepts Medicare assignment

Walgreens #17697 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)20379569

Medicare Participant SinceMarch 1, 2022

Supplier Location192 1st AveEast Ellijay, GA 30540

Phone(706) 635-2241

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.

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Other Providers at the Same Location NPPES 7

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

AMANDA K MULHERIN PHARM. D.

Pharmacist