NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #15362

  • Pharmacy
  • Eagle River, AK
National Provider Identifier
1104166479
Registry record updated Aug 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
485 Issued in AK
Legal business name
WALGREEN CO
Doing business as
Walgreens #15362
Practice address
12051 Old Glenn Hwy
Eagle River, AK 99577-7736
Phone
(907) 696-4000
Fax
(907) 696-4001
NPI assigned
Feb 25, 2013
Last updated
Aug 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jennifer Ponce
Title
Manager
Phone
(847) 527-2489

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Pharmacy 333600000X 485 AK Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

12051 Old Glenn Hwy
Eagle River, AK 99577-7736

Mailing address

1901 E Voorhees St
Ms #790
Danville, IL 61834-4509
Phone (847) 527-2489

Other identifiers 2

IdentifierTypeStateIssuer
1584122MedicaidAK
0228216OtherAKNCPDP

Other names 1

  • WALGREENS #15362 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130830000571 AK DME Supplier - Pharmacy 0941278253 Practice locations: Eagle River, AK
O20210518003132 AK Part B Supplier - Independent Clinical Laboratory 0941278253 6 other NPIs on this enrollment
Practice locations: Anchorage, AK; Soldotna, AK; Fairbanks, AK; Eagle River, AK

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
02D2062178Walgreens #1536212051 Old Glenn Hwy, Eagle River, AK 99577Certificate of waiverMar 27, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walgreens #1536212051 Old Glenn Hwy, Eagle River, AK 99577-7736(907) 696-4000 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Mar 1, 2022

National Provider Directory

National Provider Directory
Tax ID family
Walgreen Co8,684 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Organizations with this tax ID in the same state 9

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Member of 13

Organizations this organization is a member of, according to the National Provider Directory.

View all 13

Ownership & related parties

All facility ownership & control disclosures 77

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
At Home CareMechanicsville, VA, CCN 497493 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Adoration Home Health and Hospice Care East TennesseeCleveland, TN, CCN 447279 Home health agency 5% Or Greater Indirect Ownership Interest (29%) May 17, 2019
Adoration Home HealthWilliamsburg, VA, CCN 497600 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Adoration Home HealthMobile, AL, CCN 017066 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Adoration Home Health Care MississippiCleveland, MS, CCN 257305 Home health agency 5% Or Greater Indirect Ownership Interest (29%) May 17, 2019
Adoration Home HealthSan Antonio, TX, CCN 677271 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Option CareItasca, IL, CCN 147536 Home health agency 5% Or Greater Direct Ownership Interest (49%) Mar 31, 2015
Adoration Home HealthLakewood, CO, CCN 067529 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Adoration Home HealthPueblo, CO, CCN 067528 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Adoration Home Health LLCMadison, TN, CCN 447581 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Mar 5, 2019
Adoration Home HealthCarmel, IN, CCN 157691 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
@Heart HomecareVirginia Beach, VA, CCN 497744 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Aug 1, 2022
Adoration Home HealthGrand Junction, CO, CCN 067573 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Adoration Home Health Nashville SouthBrentwood, TN, CCN 447425 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Jan 1, 2021
Adoration Home Health MartinMartin, TN, CCN 447225 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Jan 13, 2025
Adoration Home Health McMinnvilleMcMinnville, TN, CCN 447316 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Jan 1, 2021
Adoration Home HealthKingsport, TN, CCN 447183 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Mar 1, 2020
Adoration Home HealthHigh Point, NC, CCN 347125 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Mar 1, 2020
Adoration Home HealthElizabethtown, NC, CCN 347097 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Mar 1, 2020
Adoration Home HealthMebane, NC, CCN 347122 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Mar 1, 2020
Adoration Home HealthRock Hill, SC, CCN 427141 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Mar 1, 2020
Adoration Home HealthAlbemarle, NC, CCN 347071 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Jan 1, 2021
Adoration Home Health and HospiceNags Head, NC, CCN 347074 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Dec 30, 2024
Adoration Home Health BaltimoreBaltimore, MD, CCN 217134 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Jan 9, 2025
Adoration Home HealthAnnandale, VA, CCN 497638 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Aug 20, 2023
Adoration Home Health MarlboroUpper Marlboro, MD, CCN 217047 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Aug 20, 2023
Adoration Home HealthLemoyne, PA, CCN 398372 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Mar 1, 2023
Adoration Home HealthPensacola, FL, CCN 687355 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Feb 17, 2023
Adoration Home HealthPlymouth, NC, CCN 347008 Home health agency 5% Or Greater Indirect Ownership Interest (29%) Sep 1, 2024
Adoration Home Health Care Rhode IslandProvidence, RI, CCN 417045 Home health agency 5% Or Greater Indirect Ownership Interest (20%) Sep 1, 2025
Hospice of North Alabama, LLCHuntsville, AL, CCN 011622 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Hospice Home Care of Pine Bluff, LLCWhite Hall, AR, CCN 041519 Hospice 5% Or Greater Indirect Ownership Interest (29%) Nov 1, 2021
Adoration Home Health and Hospice Care MississippiYazoo City, MS, CCN 251602 Hospice 5% Or Greater Indirect Ownership Interest (29%) May 17, 2019
Hospice Home Care of MonticelloMonticello, AR, CCN 041523 Hospice 5% Or Greater Indirect Ownership Interest (20%) Nov 1, 2021
Springhill Home Health & HospiceMobile, AL, CCN 011642 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Compassioncare HospiceLas Vegas, NV, CCN 291516 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Grane Hospice CarePittsburgh, PA, CCN 391674 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Oasis Healthcare, Inc.Birmingham, AL, CCN 011660 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Grane Hospice CareAltoona, PA, CCN 391693 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Allay Home & HospiceBrookfield, WI, CCN 521583 Hospice 5% Or Greater Indirect Ownership Interest (20%) Sep 2, 2021
Hospice Home Care, LLCLittle Rock, AR, CCN 041524 Hospice 5% Or Greater Indirect Ownership Interest (20%) Nov 1, 2021
Adoration Hospice Care MississippiCleveland, MS, CCN 251603 Hospice 5% Or Greater Indirect Ownership Interest (29%) May 17, 2019
Adoration Home Health and Hospice Care East TennesseeCleveland, TN, CCN 441557 Hospice 5% Or Greater Indirect Ownership Interest (29%) May 17, 2019
Apreva HospiceSan Diego, CA, CCN 551557 Hospice 5% Or Greater Indirect Ownership Interest (20%) Jan 30, 2024
Ohio Valley HospiceBeavercreek, OH, CCN 361647 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Spring Valley Hospice, LLCOlive Branch, MS, CCN 251658 Hospice 5% Or Greater Indirect Ownership Interest (20%) Nov 1, 2021
Adoration HospiceCarmel, IN, CCN 151599 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Grane Hospice CareCamp Hill, PA, CCN 391732 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Athc - Hospice, LLCMechanicsville, VA, CCN 491606 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
All Saints HospiceMansura, LA, CCN 191677 Hospice 5% Or Greater Indirect Ownership Interest (29%) Nov 1, 2021
Sacred Journey Hospice, LLCMcDonough, GA, CCN 111599 Hospice 5% Or Greater Indirect Ownership Interest (29%) Dec 9, 2020
Embrace HospiceAustin, TX, CCN 451605 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Grane Hospice CareKing of Prussia, PA, CCN 391765 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Abode Hospice of ColoradoLakewood, CO, CCN 061588 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Abode Hospice of ColoradoColorado Springs, CO, CCN 061590 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Hospice of the Midwest LLCJohnston, IA, CCN 161609 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Adoration HospiceMadison, TN, CCN 441592 Hospice 5% Or Greater Indirect Ownership Interest (29%) Mar 5, 2019
Athc - Hospice, LLCWilliamsburg, VA, CCN 491619 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Hospice of the MidwestWoodbury, MN, CCN 241600 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Compassioncare Hospice RenoReno, NV, CCN 291550 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
@Heart HospiceVirginia Beach, VA, CCN 491625 Hospice 5% Or Greater Indirect Ownership Interest (29%) Aug 1, 2022
Embrace HospiceTemple, TX, CCN 671702 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Spring Valley Hospice of TupeloTupelo, MS, CCN 251702 Hospice 5% Or Greater Indirect Ownership Interest (20%) Nov 1, 2021
Abode Hospice of ColoradoGrand Junction, CO, CCN 061605 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Embrace HospiceSan Antonio, TX, CCN 671676 Hospice 5% Or Greater Indirect Ownership Interest Mar 5, 2019
Sacred Journey Hospice, LLCLawrenceville, GA, CCN 851509 Hospice 5% Or Greater Indirect Ownership Interest (20%) Dec 9, 2020
Athc - Hospice, LLCColonial Heights, VA, CCN 491631 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Embrace HospiceNew Braunfels, TX, CCN 741721 Hospice 5% Or Greater Indirect Ownership Interest Mar 5, 2019
Athc - Hospice, LLCFredericksburg, VA, CCN 491636 Hospice 5% Or Greater Indirect Ownership Interest (20%) Apr 16, 2021
Abode Hospice of ColoradoPueblo, CO, CCN 061616 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Generations HospiceFond Du Lac, WI, CCN 521590 Hospice 5% Or Greater Indirect Ownership Interest (20%) Sep 2, 2021
Adoration HospiceOxford, AL, CCN 011629 Hospice 5% Or Greater Indirect Ownership Interest (29%) Jun 1, 2021
Adoration Home Health and HospiceNags Head, NC, CCN 341584 Hospice 5% Or Greater Indirect Ownership Interest (29%) Sep 1, 2021
Sacred Journey Hospice, LLCDalton, GA, CCN 851562 Hospice 5% Or Greater Indirect Ownership Interest (29%) Dec 9, 2020
Hospice of the MidwestSioux City, IA, CCN 161617 Hospice 5% Or Greater Indirect Ownership Interest (29%) Apr 16, 2021
Adoration HospiceBaltimore, MD, CCN 211545 Hospice 5% Or Greater Indirect Ownership Interest (29%) Aug 20, 2023
Haven HospiceGainesville, FL, CCN 101515 Hospice 5% Or Greater Indirect Ownership Interest (20%) Sep 1, 2024

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1361750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787788800000",
    "number": "1104166479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MS #790",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344509",
            "telephone_number": "847-527-2489",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12051 OLD GLENN HWY",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777736",
            "telephone_number": "907-696-4000",
            "fax_number": "907-696-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS HOLDING COMPANY",
        "enumeration_date": "2013-02-25",
        "last_updated": "2026-08-27",
        "certification_date": "2026-08-27",
        "status": "A",
        "authorized_official_last_name": "PONCE",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-527-2489"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "AK",
            "license": "485",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1584122",
            "state": "AK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "0228216",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #15362",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #15362",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle River, AK

Sources for this page

Verify at the official NPI Registry.