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	291U00000X	Clinical Medical Laboratory
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy	15342	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4587905	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629083639
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	:	7423 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-3221
Country	:	US
Telephone Number	:	210-821-6992
Fax Number	:	210-821-6632

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER PONCE
Credential	:
Telephone Number	:	847-527-2489

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/06/2026

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1356579817 — DR. RAYMOND LUNA JR. M.D.
Practice Location Address:

7407 BROADWAY
SAN ANTONIO, TX
78209-3221

Practice Phone: 281-783-8162
Practice Fax: 713-439-7995

1376871384 — MICHELLE JUNE QUINTANILLA PHARM.D.
Practice Location Address:

7423 BROADWAY ST
SAN ANTONIO, TX
78209-3221

Practice Phone: 210-821-6992
Practice Fax: 210-821-6632

1710220900 — LINDSAY D YOUNGER FNP
Practice Location Address:

7407 BROADWAY
SAN ANTONIO, TX
78209-3221

Practice Phone: 281-783-8162
Practice Fax: 281-895-3083

1437568680 — JANE DINH PHD
Practice Location Address:

7423 BROADWAY ST
SAN ANTONIO, TX
78209-3221

Practice Phone: 210-821-6992
Practice Fax:

1689073793 — DR. ROBYN BEATTY PHARMD
Practice Location Address:

7423 BROADWAY ST
SAN ANTONIO, TX
78209-3221

Practice Phone: 210-821-6992
Practice Fax:

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.