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	332B00000X	Durable Medical Equipment & Medical Supplies
2	333600000X	Pharmacy
3	3336C0003X	Community/Retail Pharmacy	PDO.0440000012	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0625698	OTHER	CO	NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003339474
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	:	1103 W PROSPECT RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80526
Country	:	US
Telephone Number	:	970-221-3073
Fax Number	:	970-221-5782

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

Provider Enumeration Date	:	07/18/2017
Last Update Date	:	01/26/2026

Similar Medicare Providers

1629928759 — ROBERT A MITCHEM III
Practice Location Address:

2260 W TRILBY RD
FORT COLLINS, CO
80526-9650

Practice Phone: 970-494-4200
Practice Fax:

1437992120 — TREVOR LIGHTNER PA
Practice Location Address:

3519 RICHMOND DR
FORT COLLINS, CO
80526-5995

Practice Phone: 970-449-0951
Practice Fax: 970-823-9004

1609726785 — BROOKE M HOWERTON
Practice Location Address:

2260 W TRILBY RD
FORT COLLINS, CO
80526-9650

Practice Phone: 970-494-4200
Practice Fax:

1477275303 — BRITTANY V HAMONS
Practice Location Address:

2260 W TRILBY RD
FORT COLLINS, CO
80526-9650

Practice Phone: 970-494-4200
Practice Fax:

1740139898 — TAYLOR HERNANDEZ MA, LPCC
Practice Location Address:

1704 PECAN ST APT 1
FORT COLLINS, CO
80526-5788

Practice Phone: 970-239-1226
Practice Fax:

1891280202 — SARA HANKINS
Practice Location Address:

1024 CENTRE AVE
FORT COLLINS, CO
80526-1884

Practice Phone: 970-224-4141
Practice Fax:

Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.