Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens #15790
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
191 W MAIN ST, ASHDOWN, AR 71822-2714
(870) 898-5151
(870) 898-2395
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0406682
NCPDP #
—
01
—
048796
STATE LICENSE
AR
05
—
187124407
—
MO
01
—
187626716
MEDICAID DME
MO
Enumeration date
09/17/2005
Last updated
06/25/2025
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