Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens #15809
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
4016 S STATE HIGHWAY 97, SAND SPRINGS, OK 74063-6673
(918) 245-6661
(918) 245-4843
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
22984
OK
333600000X
Pharmacy
22984
OK
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100233260M
—
OK
01
—
100246210M
MEDICAID DME
OK
01
—
3715844
OTHER ID NUMBER-COMMERCIAL NUMBER
—
01
—
400522490
MEDICARE FLU
OK
Enumeration date
10/25/2006
Last updated
03/28/2025
Update your record
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