Walgreen Eastern Co Inc
Organization Active NPI Pharmacy · Freeport, NY
NPI 1295740371 · NPPES record last updated Jun 15, 2026
Key facts
- NPI
- 1295740371
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pharmacy 333600000X
- License
- 20765 (NY)
- Legal business name
- WALGREEN EASTERN CO INC
- Practice address
- 89 Henry St
Freeport, NY 11520-3906 - Phone
- (516) 623-9719
- NPI assigned
- Jul 29, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- WALGREENS HOLDING COMPANY
Authorized official
- Name
- Jennifer Ponce
- Title
- Manager
- Phone
- (847) 527-2489
Other NPIs on the same Medicare enrollment 8
Corporate family (same tax ID) 18
Member of 3
Practitioners 9
-
Alexander Achenkutty, PHARMD
-
Benjamin Min Hyun Donovan, PHARMD
-
Prabhjot Kaur, PHARMD
-
Timothy D Rakiec, RPH
-
Amanda Zelinski, PHARMD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2231517 | Walgreens No 04845 | Certificate of waiver | Mar 26, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walgreen Eastern Co Inc |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TX, NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071211000174 | TX | Part B Supplier - Centralized Flu Biller | 7618929993 | This NPI is an additional NPI on the enrollment |
| O20100930009703 | NY | DME Supplier - Pharmacy | 7618929993 | Practice locations: Freeport, 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 |
National Provider Directory
- Tax ID family
- Walgreens Pharmacy 1869
- Part of
- Walgreens Holding Company
Locations
89 Henry St
Freeport, NY 11520
Phone (516) 612-9719
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | 20765 | NY | Yes |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
89 Henry St
Freeport, NY 11520-3906
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4515
Phone (847) 527-2489
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3397026 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 01210975 | Medicaid | NY |
Other names
- WALGREENS #04845
Other providers in Freeport, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.