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1982619086

NPI Code Detail

MEDICARE: WALGREEN CO

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	333600000X	Pharmacy	351	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	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	4415849	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982619086
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	:	1460 FORT CAMPBELL BLVD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-3553
Country	:	US
Telephone Number	:	931-648-1134
Fax Number	:

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	11/21/2025

Similar Medicare Providers

1316225196 — DR. WILLIAM JOSEPH ARRINGTON PHARM.D.
Practice Location Address:

1460 FORT CAMPBELL BLVD
CLARKSVILLE, TN
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Practice Fax: 931-648-8020

1326327602 — JENNIFER KLECAN
Practice Location Address:

1460 FORT CAMPBELL BLVD
CLARKSVILLE, TN
37042-3553

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Practice Fax:

1568743458 — BRYAN VAUGHN D.PH.
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1460 FORT CAMPBELL BLVD
CLARKSVILLE, TN
37042-3553

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1417339805 — DR. STEVEN LEE DEMONBREUN PHARMD
Practice Location Address:

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CLARKSVILLE, TN
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Practice Fax:

1659867463 — MEAGAN RENEE DEASON
Practice Location Address:

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CLARKSVILLE, TN
37042-3553

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Practice Fax:

1457972093 — STEPHANIE CREWS PHARMD
Practice Location Address:

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37042-3553

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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.

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