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NPI Code Detail

MEDICARE: WALGREEN CO.

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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2PH50001622OTHERMEBOARD OF PHARMACY

General Provider Information

NPI Number : 1063938652
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALGREEN CO.
Provider Business Mailing Address
First Line : 1901 E VOORHEES ST
Second Line :
City : DANVILLE
State : IL
Zip : 61834-4515
Country : US
Telephone Number : 217-709-2351
Fax Number : 217-709-2344
Provider Business Practice Location Address
First Line : 600 US ROUTE 1
Second Line :
City : SCARBOROUGH
State : ME
Zip : 04074-9776
Country : US
Telephone Number : 207-885-1515
Fax Number : 207-885-0732
Authorized Official
Title or Position : MANAGER
Name : JENNIFER PONCE
Credential :
Telephone Number : 847-527-2489
Provider Enumeration Date : 08/16/2017
Last Update Date : 05/12/2026

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