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	20790400	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	3659882	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962417972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MAILSTOP #790
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	847-527-2489
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	3415 CLARK AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-1135
Country	:	US
Telephone Number	:	216-651-0212
Fax Number	:	216-651-4675

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/10/2024

Similar Medicare Providers

1356624282 — MRS. KRISTIN MARIE HEWKO RPH
Practice Location Address:

3415 CLARK AVE
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1518243518 — KERRI J. BRADFORD RPH.
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1376810275 — MRS. DIANE MARIE JACKSON R.PH.
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1437897691 — BROOKE M HAMMILL
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1972615250 — DR. MICHELE L. PEROGINELLI PHARM.D.
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1710252358 — MR. JESSE LEON DISMON SR.
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Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

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