MEDICARE: WALGREEN CO

Medicare Provider Information

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	AR20586	AR

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0422888	OTHER	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1821255977
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	:	15500 CHENAL PKWY
Second Line	:
City	:	LITTLE ROCK
State	:	AR
Zip	:	72211-2018
Country	:	US
Telephone Number	:	501-217-3872
Fax Number	:	501-217-9824

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	09/10/2025

15524 CHENAL PKWY
LITTLE ROCK, AR
72211-2018

Practice Phone: 501-847-2229
Practice Fax: 501-847-8608

15500 CHENAL PKWY
LITTLE ROCK, AR
72211-2018