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	PHRE009423	GA

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1156290	OTHER	NCPDP

General Provider Information

NPI Number	:	1720275308
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	:	409 S COLUMBIA AVE
Second Line	:
City	:	RINCON
State	:	GA
Zip	:	31326-9446
Country	:	US
Telephone Number	:	912-826-7350
Fax Number	:	912-826-0226

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

Provider Enumeration Date	:	09/27/2007
Last Update Date	:	02/11/2026

Similar Medicare Providers

1497131841 — KEVIN NGUYEN
Practice Location Address:

409 S COLUMBIA AVE
RINCON, GA
31326-9446

Practice Phone: 912-826-7350
Practice Fax: 912-826-0226

1548778343 — STEPHANIE HARRIS PHARMD
Practice Location Address:

409 S COLUMBIA AVE
RINCON, GA
31326-9446

Practice Phone: 912-826-7350
Practice Fax:

1821629643 — FREDRICK DAVID STEESE
Practice Location Address:

461 S COLUMBIA AVE
RINCON, GA
31326-9446

Practice Phone: 912-826-7665
Practice Fax:

1891308821 — HIRAL F PATEL
Practice Location Address:

409 S COLUMBIA AVE
RINCON, GA
31326-9446

Practice Phone: 912-826-7350
Practice Fax: 912-826-0226

1932706686 — JENNIFER JOHNSON PHARMD
Practice Location Address:

461 S COLUMBIA AVE
RINCON, GA
31326-9446

Practice Phone: 912-826-7665
Practice Fax: 912-826-7667

1255939088 — BHUMIN PATEL
Practice Location Address:

461 S COLUMBIA AVE
RINCON, GA
31326-9446

Practice Phone: 912-826-7665
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.