Healthcare Provider Details

I. General information

NPI: 1376563965
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 GREEN BLVD
AURORA IN
47001-1502
US

IV. Provider business mailing address

1901 E VOORHEES ST MS #790
DANVILLE IL
61834-4515
US

V. Phone/Fax

Practice location:
  • Phone: 812-926-3424
  • Fax: 812-926-3451
Mailing address:
  • Phone: 847-527-2489
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number60006015A
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

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