Walgreen Eastern Co Inc

Primary specialty

PharmacyTaxonomy code 333600000X

License

1359 Issued in MA

Legal business name

WALGREEN EASTERN CO INC

Doing business as

Walgreens #01847

Practice address

757 Gallivan Blvd Ste 3
Dorchester, MA 02122-3190

Phone

(617) 282-5246

NPI assigned

Jul 29, 2006

Organization subpart

Yes

Parent organization

WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

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

Addresses

Other identifiers 2

Other names 1

• WALGREENS #01847 Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Part of

Walgreens Holding Company

Member of 3

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

• Walgreen Co

  dba Walgreens #02851

  • Pharmacy
  • Phoenix, AZ
  • NPI 1356356695

  Member Of

  NPD member
• Walgreen Co

  dba Walgreens #05158

  • Pharmacy
  • Rio Rancho, NM
  • NPI 1528073426

  Member Of

  NPD member
• Walgreen Co

  dba Walgreens #09514

  • Pharmacy
  • Menomonie, WI
  • NPI 1962417048

  Member Of

  NPD member

Practitioners 2

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

• Austin Anthony Puza, PHARM.D.

  • Pharmacist
  • Dorchester, MA
  • NPI 1285347583
  NPD
• Mireille Therenciel

  • Pharmacist
  • Dorchester, MA
  • NPI 1568151918
  NPD

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

{
    "created_epoch": "1154131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1336154525",
    "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": "847-527-2489",
            "fax_number": "217-709-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 GALLIVAN BLVD STE 3",
            "city": "DORCHESTER",
            "state": "MA",
            "postal_code": "021223190",
            "telephone_number": "617-282-5246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN EASTERN CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-07-29",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "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": "MA",
            "license": "1359",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0433632",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "2226769",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #01847",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #01847",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ulmiche Wagnac
• Walgreen Co
• Walgreen Co (Walgreens #06349)
• Walgreen Co (Walgreens #06805)
• Walgreen Co (Walgreens #19437)
• Debra Wallace
• Jacqueline Wallace
• Margaret Wallace
• Melissa A Wallace, EDM
• Laura Anne Walsh, RN

• Pharmacy in Dorchester, MA
• Providers in Dorchester, MA by specialty
• Pharmacy in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.