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
1	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	PH0001425	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2008591	OTHER		NCPDP

General Provider Information

NPI Number	:	1740585553
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	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-4515
Country	:	US
Telephone Number	:	217-709-2351
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	127 MARGINAL WAY
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04101-2470
Country	:	US
Telephone Number	:	207-771-5631
Fax Number	:	207-771-5645

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER PONCE
Credential	:
Telephone Number	:	224-475-5702

Provider Enumeration Date	:	01/26/2011
Last Update Date	:	01/14/2026

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Directions to “WALGREEN EASTERN CO INC ” Practice Location

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