Healthcare Provider Details

I. General information

NPI: 1336355791
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 MOUNT RUSHMORE RD
RAPID CITY SD
57701-4621
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 605-342-0194
  • Fax:
Mailing address:
  • Phone: 847-527-2489
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
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 Number100-1927
License Number StateSD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4354027
Identifier TypeOTHER
Identifier StateSD
Identifier IssuerNCPDP
# 2
Identifier8504450
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer
# 3
Identifier9167670 DME
Identifier TypeMEDICAID
Identifier StateSD
Identifier Issuer

VIII. Authorized Official

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