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Deactivated NPI 1912376310 Deactivated / Inactive NPI

Walgreen Co

Pharmacy • Lyons, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Walgreen Co has officially deactivated this NPI record and ceased active healthcare operations.

Registration / Start Date September 16, 2015
NPI Deactivation Date July 24, 2018
Total Practice Duration ~3 Years of Practice (2015 – 2018)

About Walgreen Co NPI 1912376310 Summary

Walgreen Co was a registered healthcare organization specializing in Pharmacy located in Lyons, IL. Operating from its primary practice location at 4101 1ST AVE, STE A, the facility provided medical services under NPI record 1912376310 prior to official deactivation on July 24, 2018.

Administrative records indicate Alan Nielsen as the registered authorized official.

The facility is associated with 11 linked healthcare practitioners providing clinical services.

Facility Location & Contact Primary Location

Facility Address

4101 1st Ave
Ste A

Lyons, IL 605341028

Telephone 7084476851

Authorized Official Information

Authorized Contact Name

Alan Nielsen

Official Telephone

8473153523

Facility Classifications & Specialties

Pharmacy Primary Taxonomy

NUCC Taxonomy Code: 333600000X

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.

Affiliated Practitioners & Clinicians

Healthcare professionals and specialists practicing at this facility or affiliated group locations

11 Linked
Molly Netter NPI 1194259069

Nurse Practitioner - Family

Lyons, IL

View Practitioner Profile →
Lauren Frigo NPI 1275817363

Pharmacist

Lyons, IL

View Practitioner Profile →
Laura Kukulski NPI 1285101550

Nurse Practitioner

Lyons, IL

View Practitioner Profile →

Nurse Practitioner - Family

Lyons, IL

View Practitioner Profile →

Facility & Registry History Timeline

Chronological log of verified NPI organization updates, branch relocations, and registry updates

10 Historical Events
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NPI Profile Deactivated July 24, 2018

Record deactivated on July 24, 2018

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Updated Practice Location June 15, 2018

Registered at 4101 1ST AVE, STE A, LYONS, IL 605341028 (Tel: 7084476851)

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 15, 2018

Pharmacy

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Updated Practice Location June 01, 2018

Registered at 4101 1ST AVE, STE A, LYONS, IL 60534 (Tel: 7084476851)

NPI Profile Active October 08, 2015

NPI status registered as active in NPPES database

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Updated Practice Location October 08, 2015

Registered at 4101 1ST AVE, STE A, LYONS, IL 605341028 (Tel: 7084476851)

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Updated Business Mailing Address October 08, 2015

Registered at 1901 E VOORHEES ST, MS 790, DANVILLE, IL 618344509 (Tel: 2177092386)

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Organization / Clinic Name Updated October 08, 2015

Operating as WALGREEN CO

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Medical Taxonomy / Specialty Registered (Primary Specialty) October 08, 2015

Pharmacy

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Initial NPI Registration & Enumeration September 16, 2015

First registered as active Healthcare Organization in NPPES Database.

Patient & Community Reviews

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NPI Organization Metadata

NPI Number: 1912376310
Entity Type:
Organization Organization (Hospital, Clinic, Group Practice) (Type 2 NPI)
Enumeration Date: September 16, 2015
Last Update: October 08, 2015
Deactivation Date: July 24, 2018

Mailing Address

1901 E Voorhees St, Ms 790

Danville, IL 618344509

Phone: 2177092386

Public Domain Record This organization profile is sourced from public domain datasets published by CMS and NPPES under FOIA.
⚠️ Medical Disclaimer

Facility details are provided for public information only. In case of a medical emergency, call 911 immediately.