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	291U00000X	Clinical Medical Laboratory
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy	24446	TX

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	4540313	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1962417055
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	:	3030 GOLIAD RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78223-3959
Country	:	US
Telephone Number	:	210-359-6949
Fax Number	:	210-359-6765

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/09/2026

Similar Medicare Providers

1356520126 — DR. MARC EDWARD CLOUTIER PHARMD
Practice Location Address:

3030 GOLIAD RD
SAN ANTONIO, TX
78223-3959

Practice Phone: 210-359-6949
Practice Fax: 210-359-6765

1194000505 — SMITHA ANIMIREDDY PHARMACIST
Practice Location Address:

3030 GOLIAD RD
SAN ANTONIO, TX
78223-3959

Practice Phone: 210-359-6949
Practice Fax: 210-359-6765

1588023915 — JOSEPH TORRES
Practice Location Address:

3030 GOLIAD RD
SAN ANTONIO, TX
78223-3959

Practice Phone: 210-359-6949
Practice Fax:

1003587437 — ROY CHANG PHARM.D.
Practice Location Address:

3030 GOLIAD RD
SAN ANTONIO, TX
78223-3959

Practice Phone: 210-359-6949
Practice Fax:

1538105051 — JEFFCO MANAGEMENT, LLC
Practice Location Address:

10221 DESERT SANDS ST , SUITE 206
SAN ANTONIO, TX
78216-3959

Practice Phone: 210-738-0771
Practice Fax: 210-342-1004

1104854306 — DR. JEFFREY SCOTT REYNOLDS D.C.
Practice Location Address:

10221 DESERT SANDS ST , SUITE 206
SAN ANTONIO, TX
78216-3959

Practice Phone: 210-738-0771
Practice Fax: 210-342-1004

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.