Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens #15763
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
591 S MILL ST, PRYOR, OK 74361-6015
(918) 825-5303
(918) 825-3151
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
304695
OK
333600000X
Pharmacy
304695
OK
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100241490V
—
OK
01
—
200077890C
MEDICAID DME
OK
01
—
3723586
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
400522489
MEDICARE FLU
OK
Enumeration date
10/25/2006
Last updated
03/28/2025
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