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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
3333600000XPharmacyRS00427100NJ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33130589OTHERNJNCPDP
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306952924
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 : 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 : 2353 LAKEWOOD RD
Second Line :
City : TOMS RIVER
State : NJ
Zip : 08755-1219
Country : US
Telephone Number : 732-370-1903
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : JENNIFER PONCE
Credential :
Telephone Number : 847-527-2489
Provider Enumeration Date : 08/23/2006
Last Update Date : 01/31/2026

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Directions to “WALGREEN EASTERN CO INC ” Practice Location

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