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	54009508	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1402180	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1598772584
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	:	5401 S WENTWORTH AVE
Second Line	:	STE 5A1
City	:	CHICAGO
State	:	IL
Zip	:	60609-6300
Country	:	US
Telephone Number	:	773-268-5664
Fax Number	:	773-268-4083

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

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	10/02/2025

Similar Medicare Providers

1275511925 — BARBARA ANN ZIMMERMAN MINNICH C.N.M.
Practice Location Address:

5401 S WENTWORTH AVE
CHICAGO, IL
60609-6300

Practice Phone: 773-288-6900
Practice Fax: 773-268-3020

1417039009 — PATRICIA BENITEZ MD
Practice Location Address:

5401 S WENTWORTH AVE
CHICAGO, IL
60609-6300

Practice Phone: 773-288-6900
Practice Fax: 773-268-3020

1275605792 — ACCESS COMMUNITY HEALTH NETWORK
Practice Location Address:

5401 S WENTWORTH AVE
CHICAGO, IL
60609-6300

Practice Phone: 773-268-6900
Practice Fax:

1275670440 — DYNAMIC DENTAL SERVICES, P.C.
Practice Location Address:

5401 S WENTWORTH AVE , SUITE 200
CHICAGO, IL
60609-6300

Practice Phone: 773-538-6191
Practice Fax: 773-538-8683

1992843007 — STEPHANIE R. JOHNSON O.D.
Practice Location Address:

5401 S WENTWORTH AVE STE 14B
CHICAGO, IL
60609-6300

Practice Phone: 773-924-5292
Practice Fax: 773-373-3548

1902948599 — DR. CHALICE COLEMAN D.D.S.
Practice Location Address:

5401 S WENTWORTH AVE , SUITE 200
CHICAGO, IL
60609-6300

Practice Phone: 773-548-8200
Practice Fax: 773-538-8683

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.