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	3336S0011X	Specialty Pharmacy
4	333600000X	Pharmacy	PHY49023	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5629704	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841468105
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	:	10990 WARNER AVE
Second Line	:	STE A
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-3849
Country	:	US
Telephone Number	:	714-962-7200
Fax Number	:	714-965-0469

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

Provider Enumeration Date	:	02/20/2008
Last Update Date	:	11/06/2024

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