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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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy21275NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
23321510OTHEROTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number : 1336154400
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 : 61834-4509
Country : US
Telephone Number : 847-527-2489
Fax Number : 217-709-2344
Provider Business Practice Location Address
First Line : 2095 DUTCH BROADWAY
Second Line :
City : ELMONT
State : NY
Zip : 11003-4247
Country : US
Telephone Number : 516-285-4214
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 : 06/15/2026

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Directions to “WALGREEN EASTERN CO INC ” Practice Location

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