Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens Specialty Pharmacy #13849
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
2540 NE 15TH AVE, WILTON MANORS, FL 33305-1310
(954) 390-0445
(954) 390-6368
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
PH24543
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002043900
—
FL
01
—
002043901
MEDICAID DME
FL
05
—
002043901
—
FL
01
—
1053329
NCPDP
—
Enumeration date
02/10/2010
Last updated
10/02/2025
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