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
1	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	06551012	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2586040	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366457525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
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	:	747 HIGHWAY 1 S
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38701-5958
Country	:	US
Telephone Number	:	662-335-1429
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER PONCE
Credential	:
Telephone Number	:	847-527-2489

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	01/12/2026

Similar Medicare Providers

1174135578 — PATRICIA DOWNING STADELBACHER RPH
Practice Location Address:

747 HIGHWAY 1 S
GREENVILLE, MS
38701-5958

Practice Phone: 662-335-1429
Practice Fax: 662-332-1872

1962080457 — MAKEISHA HAYGOOD PHARMD
Practice Location Address:

747 HIGHWAY 1 S
GREENVILLE, MS
38701-5958

Practice Phone: 662-335-1429
Practice Fax: 662-335-1872

1568320737 — CHA'RON KEONTYA WATT WINDER
Practice Location Address:

365 W REED RD STE A-1
GREENVILLE, MS
38701-6967

Practice Phone: 662-702-5108
Practice Fax:

1184622201 — CHESTER W JENKINS MD
Practice Location Address:

300 S WASHINGTON AVE
GREENVILLE, MS
38701-4719

Practice Phone: 662-725-1025
Practice Fax: 662-725-1023

1992704530 — JOHN M ABIDE MD
Practice Location Address:

1209 S MAIN ST
GREENVILLE, MS
38701-6342

Practice Phone: 662-335-3847
Practice Fax:

1053304881 — DEEPALI RAMDAS KALE MD
Practice Location Address:

344 ARNOLD AVE
GREENVILLE, MS
38701-4711

Practice Phone: 662-378-1311
Practice Fax: 662-335-2001

Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.