MEDICARE: WALGREEN EASTERN CO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy

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	PH50001604	OTHER	ME	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1629593694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN EASTERN CO INC

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-4515
Country	:	US
Telephone Number	:	217-709-2351
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	62 W GRAY RD
Second Line	:
City	:	GRAY
State	:	ME
Zip	:	04039-9772
Country	:	US
Telephone Number	:	207-657-2333
Fax Number	:	207-657-2062

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

Provider Enumeration Date	:	08/10/2017
Last Update Date	:	01/14/2026

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Directions to “WALGREEN EASTERN CO INC ” Practice Location

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