Healthcare Provider Details

I. General information

NPI: 1023266921
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 CHAPEL HILL RD
DOUGLASVILLE GA
30135-7287
US

IV. Provider business mailing address

1901 E VOORHEES ST MS #790
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 678-715-2578
  • Fax: 678-715-4973
Mailing address:
  • Phone: 217-709-2351
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE009529
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER PONCE
Title or Position: MANAGER
Credential:
Phone: 847-527-2489