Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens Specialty Pharmacy #21200
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
1120 E UNIVERSITY AVE STE 200, GAINESVILLE, FL 32641
(352) 327-4294
(352) 327-4295
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
—
—
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100114500
—
FL
05
—
100114501
—
FL
01
—
5737537
NCPDP
FL
01
—
7661800884
MEDICARE
FL
01
—
PH31439
BOARD OF PHARMACY
FL
Enumeration date
04/09/2018
Last updated
11/06/2024
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