Walgreen Co
Organization Active NPI Pharmacy · Lexington, KY
NPI 1124072772 · NPPES record last updated Jun 12, 2026
Key facts
- NPI
- 1124072772
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- P07122 (KY)
- Legal business name
- WALGREEN CO
- Practice address
- 101 E Reynolds Rd
Lexington, KY 40517-1249 - Phone
- (859) 272-0476
- Fax
- (859) 272-0780
- NPI assigned
- May 19, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS HOLDING COMPANY
Authorized official
- Name
- Jennifer Ponce
- Title
- Manager
- Phone
- (847) 527-2489
Member of 16
Practitioners 6
-
Ladonna Borge, R.PH.
-
Kristina Bradley, PHARMD
-
Elizabeth Bryant, PHARMD
-
V Sue Bryant, R.PH.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, KY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070917000779 | TX | Part B Supplier - Centralized Flu Biller | 0941278253 | This NPI is an additional NPI on the enrollment |
| O20210119002020 | KY | Part B Supplier - Independent Clinical Laboratory | 0941278253 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Walgreens Holding Company
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | P07122 | KY | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
101 E Reynolds Rd
Lexington, KY 40517-1249
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4509
Phone (847) 527-2489
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9001309500 DME | Medicaid | KY | |
| 1829499 | Other | NCPDP | |
| 1124072772 | Medicaid | KY |
Other names
- WALGREENS #09631
Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.