Organization
WALGREEN CO
Active
Parent organization
WALGREEN CO
Other names
WALGREENS #12549
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALGREEN CO
Authorized official
JENNIFER PONCE (MANAGER)
(847) 527-2489
Entity
Organization
Contact information
Practice address
2040 S MARIPOSA RD, STOCKTON, CA 95205-7736
(209) 465-4167
(209) 465-4873
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
—
—
333600000X
Pharmacy
Primary
PHY51040
CA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649526682
—
CA
01
—
5644693
NCPDP
—
Enumeration date
07/27/2012
Last updated
09/25/2025
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