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	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	60006116A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1561895	OTHER	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730362617
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	:	847-527-2489
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	330 N WABASH AVE STE 100
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2677
Country	:	US
Telephone Number	:	765-664-2247
Fax Number	:	765-664-2328

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

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	12/06/2024

Similar Medicare Providers

1992702096 — CHRISTOPHER DENNIS POWERS MD
Practice Location Address:

330 N WABASH AVE STE 110
MARION, IN
46952-2677

Practice Phone: 765-664-1201
Practice Fax:

1295713949 — JAMES P MACKRELL MD
Practice Location Address:

330 N WABASH AVE STE 110
MARION, IN
46952-2677

Practice Phone: 765-664-1201
Practice Fax:

1093777385 — MOHAMMAD NABI SHARIF MD
Practice Location Address:

330 N WABASH AVE STE 110
MARION, IN
46952-2677

Practice Phone: 765-664-1201
Practice Fax:

1326191289 — PATIENTFIRST MEDICAL GROUP OF MGH
Practice Location Address:

330 N WABASH AVE , SUITE 110
MARION, IN
46952-2677

Practice Phone: 765-662-4198
Practice Fax: 765-662-4012

1851674238 — MR. JOHN STEVEN KROH RPH
Practice Location Address:

330 N WABASH AVE STE 100
MARION, IN
46952-2677

Practice Phone: 765-664-2247
Practice Fax: 765-664-2328

1861832594 — IHAB AJAAJ M.D
Practice Location Address:

330 N WABASH AVE STE 110
MARION, IN
46952-2677

Practice Phone: 765-664-1201
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.