Walgreen Co
Pharmacy in South Farmingdale, NY. Organization (NPI-2).
NPI number1790790863
StatusActive
Last updated in NPPESOct 26, 2026
Details
- NPI
- 1790790863
- Entity type
- Organization (NPI-2)
- Legal business name
- Walgreen Co
- Organization subpart
- Yes
- Enumeration date
- Jul 29, 2006
- Certification date
- Oct 26, 2026
- Last updated
- Oct 26, 2026
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · DME SUPPLIER - PHARMACY
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 333600000X | Pharmacy | 25028 | NY | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | – | – | |
| 3336C0003X | Pharmacy, Community/Retail Pharmacy | – | – |
Other names
- Walgreens #04920 (Doing Business As)
Practice location
918 Main St Ste 20South Farmingdale, NY 11735-5426
Phone 516-845-5235 · Fax 516-845-5263
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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