| NPI | 1104847375 |
|---|---|
| NPI Type | NPI-2 Organization |
| Status | Active |
| Enumeration Date | 2006-07-22 |
| Last Updated | 2024-09-30 |
| Authorized Official | Jennifer Ponce MANAGER Phone: 8475272489 |
| Mailing Address | 1901 E Voorhees St, Ms #790 Danville, IL 61834-4509 United States Phone: (847) 527-2489 | Fax: (217) 709-2344 📍 View Map |
| Primary Practice Address | 705 S State St Jerseyville, IL 62052-2340 United States Phone: (618) 498-4989 | Fax: (618) 498-8648 📍 View Map |
| Issuer | State | Number | Other Issuer |
|---|---|---|---|
| Other (non-Medicare) | — | 1479799 | NCPDP |
| MEDICAID | IL | ========= | — |
| Primary | Taxonomy Code & Description | State | License Number |
|---|---|---|---|
| No | 332B00000X – Durable Medical Equipment & Medical Supplies | — | — |
| Yes | 333600000X – Pharmacy | IL | 054.019058 |
| No | 3336C0003X – Pharmacy, Community/Retail Pharmacy | — | — |
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About NPI 1104847375
Walgreen Co is an organization registered in the CMS NPPES NPI Registry with NPI number 1104847375. The primary specialty listed is Pharmacy. The organization is located in Jerseyville, IL. This NPI is classified as a Type 2 (Organizational) NPI and is currently active. The NPI was first enumerated (assigned) on 2006-07-22. All data is sourced directly from the official CMS NPPES public API and is updated daily.
Frequently Asked Questions
What is NPI 1104847375?
NPI 1104847375 belongs to Walgreen Co, a Pharmacy in Jerseyville, IL. It is a Type 2 Organizational NPI registered in the CMS NPPES NPI Registry.
Is NPI 1104847375 active?
The current status of NPI 1104847375 in the NPPES registry is Active. The record was last updated on 2024-09-30.
What specialty is NPI 1104847375?
NPI 1104847375 is classified under the taxonomy Pharmacy. Taxonomy codes in NPPES are maintained by the National Uniform Claim Committee (NUCC) and identify the provider's type, classification, and specialization.
How do I verify NPI 1104847375?
You can verify NPI 1104847375 at the official CMS NPPES website at npiregistry.cms.hhs.gov or using our free NPI Lookup tool above. All data shown on this page is sourced directly from the official NPPES public API and is updated daily by CMS.
What address is on file for NPI 1104847375?
The primary practice address on file for NPI 1104847375 is 705 S State St, Jerseyville, IL 62052-2340. This address is registered in the NPPES system and providers are required to update it within 30 days of any change.
When was NPI 1104847375 issued?
NPI 1104847375 was first issued (enumerated) on 2006-07-22. The NPPES record was last updated on 2024-09-30.
Practice Location Map
Walgreen Co is located at 705 S State St, Jerseyville, IL. Use the map below to find directions or verify the practice location.
Related Healthcare Providers
The following providers share the same practice location, specialty, or state as Walgreen Co. All records sourced from the CMS NPPES registry.
License Information
The following state license numbers are on file in the NPPES registry for NPI 1104847375. For license status verification, contact the relevant state licensing board directly.
| Specialty / Taxonomy | License Number | State |
|---|---|---|
| Pharmacy | 054.019058 | IL |