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	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	PHY45606	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0563533	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083629372
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	:	1301 E 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-8503
Country	:	US
Telephone Number	:	714-541-1747
Fax Number	:

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	06/09/2026

Similar Medicare Providers

1740562859 — UYEN-NHI HO PHARMD
Practice Location Address:

1301 E 17TH ST
SANTA ANA, CA
92705-8503

Practice Phone: 714-541-1747
Practice Fax:

1962784074 — THO HA PHARMD
Practice Location Address:

1301 E 17TH ST
SANTA ANA, CA
92705-8503

Practice Phone: 714-541-1747
Practice Fax:

1972885648 — DR. CECILE TAYLOR PHARM.D.
Practice Location Address:

1301 E 17TH ST
SANTA ANA, CA
92705-8503

Practice Phone: 714-541-1747
Practice Fax: 714-541-2226

1003453192 — DR. JOSEPH M FILLY PHARMACIST
Practice Location Address:

1301 E 17TH ST
SANTA ANA, CA
92705-8503

Practice Phone: 714-541-1747
Practice Fax: 714-541-2226

1619217718 — SHARI HUNTER BCBA
Practice Location Address:

26028 CAYMAN PL
SANTA CLARITA, CA
91350-8503

Practice Phone: 714-745-3300
Practice Fax:

1477817039 — MS. ANA ROSA GUZMAN
Practice Location Address:

1510 WATERS PL
BRONX, NY
10461-2700

Practice Phone: 347-493-8503
Practice Fax: 171-891-8946

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.