WALGREENS SPECIALTY PHARMACY LLC

Provider Demographics

• NPI: 1851463087
• Name: WALGREENS SPECIALTY PHARMACY LLC
• Entity Type: Organization
• Organization Name: WALGREENS SPECIALTY PHARMACY LLC
• Other - Org Name: ALLIANCERX WALGREENS PHARMACY #15443
• Other - Org Type: Doing Business As
• Authorized Official - Title/Position: MANAGER
• Authorized Official - First Name: KIRA
• Authorized Official - Last Name: TAYLOR
• Authorized Official - Phone: 217-709-2351
• Mailing Address - Street 1: 1901 E VOORHEES ST
• Mailing Address - Street 2: MS 790
• Mailing Address - City: DANVILLE
• Mailing Address - State: IL
• Mailing Address - Zip Code: 61834-4509
• Mailing Address - Country: US
• Mailing Address - Phone: 217-709-2386
• Mailing Address - Fax: 217-709-2344
• Practice Address - Street 1: 10530 JOHN W ELLIOTT DR
• Practice Address - Street 2: STE 100
• Practice Address - City: FRISCO
• Practice Address - State: TX
• Practice Address - Zip Code: 75033
• Practice Address - Country: US
• Practice Address - Phone: 800-424-9002
• Practice Address - Fax: 800-874-9179
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: WALGREENS BOOTS ALLIANCE
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-11-14
• Last Update Date: 2023-03-07

Provider Licenses

State	License ID	Taxonomies
		332B00000X, 3336H0001X
TX	14412	333600000X, 3336S0011X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	333600000X	Suppliers	Pharmacy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy
No	3336S0011X	Suppliers	Pharmacy	Specialty Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
VA	1851463087	Medicaid
TX	466694	Medicaid
TN	491055	Medicaid
OR	500638341	Medicaid
HI	685282-01	Medicaid
NV	1851463087	Medicaid
MD	554204900	Medicaid
MN	1851463087	Medicaid
UT	1851463087	Medicaid
IN	200390000A	Medicaid
NH	3124086	Medicaid
AZ	498604	Medicaid
SC	7T4412	Medicaid
PA	00196328280006	Medicaid
OH	0216495	Medicaid
MI	1851463087	Medicaid
ID	1851463087	Medicaid
	4591055	Other	NCPDP
MS	07033855	Medicaid
AK	1028472	Medicaid
WY	119788601	Medicaid
IA	1851463087	Medicaid
AR	185350407	Medicaid
MT	1851463087	Medicaid
NM	96722339	Medicaid
SD	1851463087	Medicaid
OK	200037560A	Medicaid
WA	2013289	Medicaid
LA	2204947	Medicaid
KY	7100151520	Medicaid
KY	7100151520	Medicaid