Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens Specialty Pharmacy #16374
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALGREENS BOOTS ALLIANCE INC
Authorized official
JENNIFER PONCE (MANAGER)
(847) 527-2489
Entity
Organization
Contact information
Practice address
4501 WOODWARD AVE, SUITE 105, DETROIT, MI 48201-1890
(313) 230-2170
(312) 230-2004
Mailing address
1901 E VOORHEES ST # MS 790, DANVILLE, IL 61834-4515
(847) 527-2489
(217) 709-2344
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
MI
333600000X
Pharmacy
Primary
5301010747
MI
3336C0003X
Community/Retail Pharmacy
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063883403
—
MI
01
—
2381262
NCPDP
MI
Enumeration date
10/12/2015
Last updated
06/25/2025
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