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	PDO823	CO
3	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	89029330	OTHER	CO	DME
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0622046	OTHER	CO	NCPDP

General Provider Information

NPI Number	:	1225336357
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	:	61834-4509
Country	:	US
Telephone Number	:	217-709-2364
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	16950 E SMOKY HILL RD
Second Line	:
City	:	CENTENNIAL
State	:	CO
Zip	:	80015-2482
Country	:	US
Telephone Number	:	303-627-0045
Fax Number	:	303-627-0063

Authorized Official
Title or Position	:	MANAGER
Name	:	VIRGINIA GARZA
Credential	:
Telephone Number	:	217-709-2364

Provider Enumeration Date	:	03/15/2011
Last Update Date	:	06/20/2024

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Directions to “WALGREEN CO ” Practice Location

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