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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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacyPHY46230CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
20587797OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417962747
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALGREEN CO
Provider Business Mailing Address
First Line : 1901 E VOORHEES ST
Second Line : MS 790
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 : 5224 COLDWATER CANYON AVE
Second Line :
City : VAN NUYS
State : CA
Zip : 91401-6146
Country : US
Telephone Number : 818-487-2715
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 : 05/20/2026

Similar Medicare Providers

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Practice Fax:
1881963296 — HARRY STAPLETON
Practice Location Address:
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91401-6146
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Practice Fax:
1346519303 — DR. JASON JAVAHERIFAR PHARM D.
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VAN NUYS, CA
91401-6146
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1639618093 — TRAVIS STARK
Practice Location Address:
5224 COLDWATER CANYON AVE
VAN NUYS, CA
91401-6146
Practice Phone: 818-487-2715
Practice Fax: 818-487-7364

Directions to “WALGREEN CO ” Practice Location

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