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	332B00000X	Durable Medical Equipment & Medical Supplies	24501	OK
2	333600000X	Pharmacy	24501	OK
3	3336C0003X	Community/Retail Pharmacy

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	400522490	OTHER	OK	MEDICARE FLU

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	3718953	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1982788642
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	:	6040 S YALE AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74135-7412
Country	:	US
Telephone Number	:	918-494-4040
Fax Number	:	918-496-4702

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	03/28/2025

Similar Medicare Providers

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Practice Location Address:

6050 S YALE AVE
TULSA, OK
74135-7412

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1003065798 — DR. BRADLEY HOWARD BROWN PHARMD
Practice Location Address:

6040 S YALE AVE
TULSA, OK
74135-7412

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1326298969 — JENNIFER ELIZABETH WOOD
Practice Location Address:

6040 S YALE AVE
TULSA, OK
74135-7412

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Practice Fax:

1114420833 — DR. MICHAEL GLENN GRUNEWALD PHARMD
Practice Location Address:

6040 S YALE AVE
TULSA, OK
74135-7412

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Practice Fax: 918-496-4702

1336790054 — JORDAN HERRMAN
Practice Location Address:

6040 S YALE AVE
TULSA, OK
74135-7412

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Practice Fax:

1508636507 — ACUITY RETAIL RICHARDS, LLC
Practice Location Address:

6038 S YALE AVE
TULSA, OK
74135-7412

Practice Phone: 918-492-6087
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Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

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