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NPI Code Detail

MEDICARE: WALGREEN EASTERN CO INC

MEDICARE: WALGREEN EASTERN CO INC
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
13336C0003XCommunity/Retail Pharmacy
2332B00000XDurable Medical Equipment & Medical Supplies
3333600000XPharmacy

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PH50001567OTHERMEBOARD OF PHARMACY
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154846772
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALGREEN EASTERN CO INC
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 : 317 MAIN ST
Second Line :
City : FARMINGTON
State : ME
Zip : 04938-5803
Country : US
Telephone Number : 207-778-3919
Fax Number : 207-778-3703
Authorized Official
Title or Position : MANAGER
Name : JENNIFER PONCE
Credential :
Telephone Number : 847-527-2489
Provider Enumeration Date : 08/04/2017
Last Update Date : 01/14/2026

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Directions to “WALGREEN EASTERN CO INC ” Practice Location

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