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Contact Information

WALGREENS SPECIALTY PHARMACY LLC
9775 SW GEMINI DR
STE 1
BEAVERTON, OR97008
 Phone: 866-202-4014
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
 

Home Infusion Therapy Pharmacy

3336H0001X 58 Medical Supply Company with Pharmacist
 

Specialty Pharmacy

3336S0011X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for WALGREENS SPECIALTY PHARMACY LLC

NPI Number 1669668752
LBN Legal business name WALGREENS SPECIALTY PHARMACY LLC
Authorized official KIRA TAYLOR - (MANAGER)
Entity Organization
Organization subpart 1 Yes
Enumeration date 09/21/2007
Last updated 05/11/2021 - About 5 years ago
Identifiers
OR License # RP-0002419
AK Medicaid 1028445
AZ Medicaid 320618
CO Medicaid 44039751
HI Medicaid 685274-01
IA Medicaid 1669668752
ID Medicaid 1669668752
IN Medicaid 200923000A
KS Medicaid 200333400E
KY Medicaid 7100277090
MD Medicaid 554205700
MI Medicaid 1669668752
MN Medicaid 1669668752
MT Medicaid 1669668752
ND Medicaid 457263
NM Medicaid 37104811
OH Medicaid 0216467
OK Medicaid 200135400A
OR Medicaid 278926
PA Medicaid 1021135430001
SC Medicaid 7R2419
TN Medicaid 3842944
UT Medicaid 1669668752
VA Medicaid 1669668752
WA Medicaid 1092434
Other 3842944 NCPDP
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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