Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens Specialty Pharmacy #16297
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
9400 NW 12TH AVE BAY 5, MIAMI, FL 33150-2024
(305) 696-8803
(305) 696-8809
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
PH23634
FL
3336C0003X
Community/Retail Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000469300
—
FL
01
—
000469301
FL MEDICAID DME
FL
01
—
1038656
NCPDP
—
Enumeration date
10/02/2008
Last updated
01/12/2026
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