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	60003073	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1532666	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598770638
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	:	110 E CREIGHTON AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46803-3344
Country	:	US
Telephone Number	:	260-456-1841
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	:	09/08/2025

Similar Medicare Providers

1396028171 — MR. PATRICK DEWAYNE SHANNON
Practice Location Address:

110 E CREIGHTON AVE
FORT WAYNE, IN
46803-3344

Practice Phone: 260-456-1841
Practice Fax:

1093167488 — EHLIMANA HAMIDOVIC
Practice Location Address:

110 E CREIGHTON AVE
FORT WAYNE, IN
46803-3344

Practice Phone: 260-456-1841
Practice Fax:

1306465570 — DR. MARIAH VASQUEZ PHARMD
Practice Location Address:

110 E CREIGHTON AVE
FORT WAYNE, IN
46803-3344

Practice Phone: 260-456-1841
Practice Fax:

1124034640 — LEONAUM PHARMACY INC.
Practice Location Address:

4910 FORT HAMILTON PKWY
BROOKLYN, NY
11219-3344

Practice Phone: 718-437-4699
Practice Fax: 718-437-0796

1467523399 — HANGER PROSTHETICS & ORTHOTICS INC
Practice Location Address:

12591 CREEKSIDE LN
FORT MYERS, FL
33919-3344

Practice Phone: 239-437-0800
Practice Fax:

1629117692 — BENJAMIN JON ROGERS D.C.
Practice Location Address:

705 N 15TH ST
FORT DODGE, IA
50501-3344

Practice Phone: 515-576-1176
Practice Fax: 515-573-5295

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.