Walgreen Co
Pharmacy in Gulfport, MS. Organization (NPI-2).
NPI number1477568632
StatusActive
Last updated in NPPESOct 12, 2026
Details
- NPI
- 1477568632
- Entity type
- Organization (NPI-2)
- Legal business name
- Walgreen Co
- Organization subpart
- Yes
- Enumeration date
- Jul 29, 2006
- Certification date
- Oct 12, 2026
- Last updated
- Oct 12, 2026
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | 0465101WG | MS | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – |
Other names
- Walgreens #05195 (Doing Business As)
Practice location
15371 Dedeaux RdGulfport, MS 39503-3855
Phone 228-539-9890
Mailing address
1901 E Voorhees StMs 790
Danville, IL 61834-4515
Phone 847-527-2489 · Fax 217-709-2344
Authorized official
Jennifer Ponce
Manager
8475272489
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All 10 Pharmacy providers in Gulfport · All 2,821 providers in Gulfport
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