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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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacyPH1064NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12905745OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
53302124OTHERNVDME
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1629083688
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 : 2280 N LAS VEGAS BLVD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-5803
Country : US
Telephone Number : 702-649-1415
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 : 06/17/2025

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Directions to “WALGREEN CO ” Practice Location

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