Organization · NPI-2
Walgreen Co
Pharmacy · Port Jervis, NY
NPI number1023533791
StatusActive
Last updated in NPPESJun 24, 2026
Details
- NPI
- 1023533791
- Entity type
- Organization (NPI-2)
- Legal business name
- Walgreen Co
- Organization subpart
- Yes
- Enumeration date
- Aug 3, 2017
- Certification date
- Jun 24, 2026
- Last updated
- Jun 24, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | 036350 | NY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – |
Other names
- Walgreens #19500 (Doing Business As)
Practice location
76 Pike StPort Jervis, NY 12771-1827
Phone 845-856-8342 · Fax 845-856-3501
Mailing address
1901 E Voorhees StMs 790
Danville, IL 61834-4509
Phone 217-709-2351 · Fax 217-709-2344
Authorized official
Kira Taylor
Manager
2177092351
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