WALGREENS #09890 – Community/Retail Pharmacy, NPI 1295779577

WALGREENS #09890 is a healthcare provider. based in Newnan, Georgia. specializing in Community/Retail Pharmacy. The organization holds a License No. PHRE009043 (GA). The NPI Number for WALGREENS #09890 is 1295779577

Main info

Organization
Name
WALGREENS #09890
NPI
1295779577
Phone
(770) 251-6778
Address
1 MILLARD FARMER IND BLVD
Authorized Official
JENNIFER PONCE MANAGER
Enumeration Date
16 June 2006
Last Update Date
8 October 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience67
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

Provider Addresses for WALGREENS #09890

  • 1 MILLARD FARMER IND BLVD

    NEWNAN, GA 302631078

    Phone: (770) 251-6778

    Fax: (770) 251-9192

    Type: Location

  • Millard Farmer Industrial Boulevard, Newnan, Coweta County, Georgia, 30264, United States

    NEWNAN, GA 302631078

    Phone: (770) 251-6778

    Fax: (770) 251-9192

    Type: Location

  • 1901, East Voorhees Street, Danville, Vermilion County, Illinois, 61832, United States

    MS 790

    DANVILLE, IL 618344509

    Phone: (847) 527-2489

    Fax: (217) 709-2344

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-09-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2024-10-31 (587 days ago).

Enrollment records

1

Earliest due date

2024-10-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20100930068111OPharmacyGA2024-10-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count27633$0
G0008Administration of influenza virus vaccine104104$0
90480Admn sarscov2 vacc 1 dose7070$0
91320Sarscv2 vac 30mcg trs-suc im6969$0
90694Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage6666$0
View full utilization report →

Insurance plans in this area (ZIP 30263)

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Reviews

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Frequently asked questions

What unique ID ties claims to WALGREENS #09890?
NPI 1295779577 is assigned to WALGREENS #09890 under the national enumeration system.
Is WALGREENS #09890's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is WALGREENS #09890?
The page reflects Community/Retail Pharmacy for WALGREENS #09890. Clinical services aligned with this taxonomy classification.
Where does public data place WALGREENS #09890?
The snapshot lists Newnan, Georgia for WALGREENS #09890; download NPPES for the complete set.
What if Newnan, Georgia seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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