NPIMap

Organization Active NPI

Walgreen Eastern Co Inc

Doing business as Walgreens #03859

  • Pharmacy
  • Depew, NY
National Provider Identifier
1174530125
Registry record updated Jun 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
23101 Issued in NY
Legal business name
WALGREEN EASTERN CO INC
Doing business as
Walgreens #03859
Practice address
4815 Broadway
Depew, NY 14043-3926
Phone
(716) 683-7971
NPI assigned
Aug 2, 2006
Last updated
Jun 15, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS HOLDING COMPANYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 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 23101 NY Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

4815 Broadway
Depew, NY 14043-3926

Mailing address

1901 E Voorhees St
Ms 790
Danville, IL 61834-4515
Phone (847) 527-2489

Other identifiers 2

IdentifierTypeStateIssuer
01705953MedicaidNY
3317078OtherOTHER ID NUMBER-COMMERCIAL NUMBER

Other names 1

  • WALGREENS #03859 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071211000174 TX Part B Supplier - Centralized Flu Biller 7618929993 This NPI is an additional NPI on the enrollment
O20100930051894 NY DME Supplier - Pharmacy 7618929993 Practice locations: Depew, NY
O20221222000663 NY Part B Supplier - Independent Clinical Laboratory 7618929993 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Amherst, NY; Tonawanda, NY; Lackawanna, NY; Kingston, NY; Huntington Station, NY; Hicksville, NY; Freeport, NY; Depew, NY

Other NPIs on the same Medicare enrollment 8

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walgreen Eastern Co Inc4815 Broadway, Depew, NY 14043-3926(716) 683-7971 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

National Provider Directory

National Provider Directory
Tax ID family
Walgreens Pharmacy 2267338 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Organizations with this tax ID in the same state 15

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

View all 15

Member of 3

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781481600000",
    "number": "1174530125",
    "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": "618344515",
            "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": "4815 BROADWAY",
            "city": "DEPEW",
            "state": "NY",
            "postal_code": "140433926",
            "telephone_number": "716-683-7971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN EASTERN CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS HOLDING COMPANY",
        "enumeration_date": "2006-08-02",
        "last_updated": "2026-06-15",
        "certification_date": "2026-06-15",
        "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": "NY",
            "license": "23101",
            "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": "01705953",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "3317078",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #03859",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #03859",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Depew, 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.