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NPI Code Detail

MEDICARE: WALGREEN CO

MEDICARE: WALGREEN CO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1291U00000XClinical Medical Laboratory
2332B00000XDurable Medical Equipment & Medical Supplies
33336C0003XCommunity/Retail Pharmacy
4333600000XPharmacy17057TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
24596839OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1184631194
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALGREEN CO
Provider Business Mailing Address
First Line : 1901 E VOORHEES ST # MS 790
Second Line :
City : DANVILLE
State : IL
Zip : 61834-4515
Country : US
Telephone Number : 847-527-2489
Fax Number : 217-709-2344
Provider Business Practice Location Address
First Line : 3425 SYCAMORE SCHOOL RD
Second Line :
City : FORT WORTH
State : TX
Zip : 76123-3030
Country : US
Telephone Number : 817-370-0505
Fax Number : 817-370-2219
Authorized Official
Title or Position : MANAGER
Name : JENNIFER PONCE
Credential :
Telephone Number : 847-527-2489
Provider Enumeration Date : 08/02/2006
Last Update Date : 06/17/2025

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3425 SYCAMORE SCHOOL RD
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1639406622 — MRS. KRISTA D SANDERS RPH
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1619214764 — SOUMAVA SEN, DDS, P.C.
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Practice Location Address:
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1932732872 — KIM MINH THI NGUYEN PHARMD
Practice Location Address:
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Practice Fax:

Directions to “WALGREEN CO ” Practice Location

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