NPIMap

Organization Active NPI

Walgreen Eastern Co Inc

  • Pharmacy
  • Queens Village, NY
National Provider Identifier
1104831288
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
20874 Issued in NY
Legal business name
WALGREEN EASTERN CO INC
Practice address
10962 Francis Lewis Blvd
Queens Village, NY 11429-1723
Phone
(718) 740-4612
NPI assigned
Jul 29, 2006
Organization subpart
Yes
Parent organization
WALGREENS HOLDING COMPANYAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kira Taylor
Title
Manager
Phone
(217) 709-2351

Member of 3

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

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

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
33D2295841Walgreens No 0205510962 Francis Lewis Blvd, Queens Village, NY 11429Certificate of waiverMar 26, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walgreens #205510962 Francis Lewis Blvd, Queens Village, NY 11429-1753(718) 740-4988 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) Accepts assignmentParticipating since Jan 1, 2023

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20071211000174 TX Part B Supplier - Centralized Flu Biller 7618929993 This NPI is an additional NPI on the enrollment
O20100930004872 NY DME Supplier - Pharmacy 7618929993 Practice locations: Queens Village, NY

National Provider Directory

National Provider Directory
Tax ID family
Walgreens Pharmacy 1869338 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Organizations with this tax ID in the same state 14

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

View all 14

Specialties & licenses 3

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X 20874 NY Primary
Community/Retail Pharmacy 3336C0003X

Addresses

NPPES NPI Registry

Primary practice location

10962 Francis Lewis Blvd
Queens Village, NY 11429-1723

Mailing address

1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (217) 709-2351

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
3397987OtherOTHER ID NUMBER-COMMERCIAL NUMBER
01230437MedicaidNY

Other names 1

NPPES NPI Registry
  • WALGREENS #02055 Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 15, 2026.

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1104831288",
    "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": "217-709-2351",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10962 FRANCIS LEWIS BLVD",
            "city": "QUEENS VILLAGE",
            "state": "NY",
            "postal_code": "114291723",
            "telephone_number": "718-740-4612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN EASTERN CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS HOLDING COMPANY",
        "enumeration_date": "2006-07-29",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "KIRA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "217-709-2351"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NY",
            "license": "20874",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3397987",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01230437",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #02055",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #02055",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Queens Village, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.