WALGREENS #05901 – Pharmacy, NPI 1881601862

WALGREENS #05901 is a healthcare provider. based in Smyrna, Georgia. specializing in Pharmacy. The organization holds a License No. PHRE008621 (GA). The NPI Number for WALGREENS #05901 is 1881601862

Main info

Organization
Name
WALGREENS #05901
NPI
1881601862
Phone
(678) 556-0673
Address
2390 S COBB DR SE
Authorized Official
JENNIFER PONCE MANAGER
Enumeration Date
2 August 2006
Last Update Date
4 October 2024
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness80
Years active:19State licenses:1Digital endpointsUpdated within 12 months

Provider Addresses for WALGREENS #05901

  • 2390 S COBB DR SE

    SMYRNA, GA 300801359

    Phone: (678) 556-0673

    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 (588 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
O20100930074920OPharmacyGA2024-10-31

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 count25522$0
G0008Administration of influenza virus vaccine7171$0
90480Admn sarscov2 vacc 1 dose6666$0
91320Sarscv2 vac 30mcg trs-suc im6666$0
90662Influenza vaccine split virus, preservative free5050$0
View full utilization report →

Insurance plans in this area (ZIP 30080)

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Reviews

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Frequently asked questions

Where can patients find WALGREENS #05901's NPI?
You can confirm WALGREENS #05901 with NPI 1881601862; it appears in the national provider directory.
Is WALGREENS #05901's enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What does WALGREENS #05901 treat or focus on?
Patients typically see WALGREENS #05901 under the specialty Pharmacy. Clinical services aligned with this taxonomy classification.
Where is WALGREENS #05901's primary listing?
We display Smyrna, Georgia because that is what the record indicates for WALGREENS #05901.
Is WALGREENS #05901 a real provider?
This page reflects official NPPES data for NPI 1881601862. Always confirm identity and privileges with the practice and licensing boards.

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