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	50007149	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4224678	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194730283
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	:	2410 REIDVILLE RD
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29301-3652
Country	:	US
Telephone Number	:	864-587-9486
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	:	09/08/2025

Similar Medicare Providers

1588122501 — BRANDI SHAYE MOORE PA
Practice Location Address:

2430 REIDVILLE RD
SPARTANBURG, SC
29301-3652

Practice Phone: 864-516-1783
Practice Fax:

1699889998 — DR. JEREMY ROSS BURNS OD
Practice Location Address:

2428 REIDVILLE RD
SPARTANBURG, SC
29301-3652

Practice Phone: 864-576-7225
Practice Fax: 864-576-7226

1295032423 — OLABISI C OBINWANNE PHARM D
Practice Location Address:

2410 REIDVILLE RD
SPARTANBURG, SC
29301-3652

Practice Phone: 864-587-9486
Practice Fax: 864-587-9504

1609174465 — CRYSTAL B GARCIA RPH
Practice Location Address:

2410 REIDVILLE RD
SPARTANBURG, SC
29301-3652

Practice Phone: 864-587-9486
Practice Fax: 864-587-9504

1912296104 — DR. KRISTI G. SHOCKLEY PHARMD
Practice Location Address:

2410 REIDVILLE RD
SPARTANBURG, SC
29301-3652

Practice Phone: 864-587-9486
Practice Fax: 864-587-9504

1164715843 — LIFETIME EYECARE ASSOCIATES LLC
Practice Location Address:

2428 REIDVILLE RD
SPARTANBURG, SC
29301-3652

Practice Phone: 864-576-7225
Practice Fax: 864-576-7226

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.