NPIMap

Organization Active NPI

Walgreen Co

Doing business as Walgreens #00936

  • Pharmacy
  • Bayamon, PR
National Provider Identifier
1316952476
Registry record updated Aug 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
19-F-3466 Issued in PR
Legal business name
WALGREEN CO
Doing business as
Walgreens #00936
Walgreens #21593
Practice address
300 Avenida Main Ste 110
Urb. Santa Rosa
Bayamon, PR 00959-0000
Phone
(787) 787-0001
NPI assigned
Jul 29, 2006
Last updated
Aug 21, 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 21, 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
Pharmacy 333600000X 19-F-3466 PR Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

300 Avenida Main Ste 110
Urb. Santa Rosa
Bayamon, PR 00959-0000

Mailing address

1901 E Voorhees St
Danville, IL 61834-4515
Phone (217) 709-2351

Other identifiers 1

IdentifierTypeStateIssuer
4024535OtherOTHER ID NUMBER COMMERCIAL NUMBER

Other names 2

  • WALGREENS #00936 Doing business as
  • WALGREENS #21593 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, PR2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070917000779 TX Part B Supplier - Centralized Flu Biller 0941278253 This NPI is an additional NPI on the enrollment
O20210624001425 PR Part B Supplier - Independent Clinical Laboratory 0941278253 This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Part of
Walgreens Holding Company

Member of 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787270400000",
    "number": "1316952476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "city": "DANVILLE",
            "state": "IL",
            "postal_code": "618344515",
            "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": "300 AVENIDA MAIN STE 110",
            "address_2": "URB. SANTA ROSA",
            "city": "BAYAMON",
            "state": "PR",
            "postal_code": "009590000",
            "telephone_number": "787-787-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS HOLDING COMPANY",
        "enumeration_date": "2006-07-29",
        "last_updated": "2026-08-21",
        "certification_date": "2026-08-21",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "PR",
            "license": "19-F-3466",
            "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": "4024535",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #00936",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #21593",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bayamon, PR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.