Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens Specialty Pharmacy #15106
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
1250 NW 7TH ST STE 205, MIAMI, FL 33125-3744
(305) 547-4790
(305) 925-9560
Mailing address
1901 E VOORHEES ST, MS 790, DANVILLE, IL 61834-4509
(847) 527-2489
(217) 709-2344
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH25441
FL
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003510500
—
FL
01
—
003510501
MEDICAID DME
FL
05
—
003510501
—
FL
01
—
5705136
NCPDP
—
05
—
59911
—
TX
05
—
7E5441
—
SC
Enumeration date
12/14/2010
Last updated
11/26/2024
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