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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
3333600000XPharmacy3284TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14431831OTHEROTHER 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

General Provider Information

NPI Number : 1669487674
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 : 1954 MADISON ST
Second Line :
City : CLARKSVILLE
State : TN
Zip : 37043-8038
Country : US
Telephone Number : 931-552-8108
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 : 11/21/2025

Similar Medicare Providers

1265713853 — DR. PAUL SMITH
Practice Location Address:
1954 MADISON ST
CLARKSVILLE, TN
37043-8038
Practice Phone: 931-552-8108
Practice Fax:
1720362205 — DR. ANGELA POLLOCK LOUGHERY PHARMD
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1649554916 — MR. ADAM L STEIMER PHARMD
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1518241629 — DR. LANNY MIZE PHARM.D.
Practice Location Address:
1954 MADISON ST
CLARKSVILLE, TN
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1538445309 — DALE ALAN CHRISTENSEN PHARMD
Practice Location Address:
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1225314743 — AMANDA SEARS MAYES PHARMD
Practice Location Address:
1954 MADISON ST
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37043-8038
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Directions to “WALGREEN CO ” Practice Location

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