Walgreen Co

Primary specialty

PharmacyTaxonomy code 333600000X

License

2017006071 Issued in MO

Legal business name

WALGREEN CO

Practice address

904 W Business US Highway 60
Dexter, MO 63841-2701

Phone

(573) 624-7452

Fax

(573) 624-6867

NPI assigned

Sep 5, 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 #15800 Doing business as

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Medicare medical equipment & supply locations

Tax ID family

Walgreen Co8,684 organizations share this tax ID, including this one

Part of

Walgreens Holding Company

Organizations with this tax ID in the same state 24

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

• Walgreen Co

  • Pharmacy
  • Wentzville, MO
  • NPI 1326225277
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Bonne Terre, MO
  • NPI 1326394362
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Raytown, MO
  • NPI 1336154350
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Saint Louis, MO
  • NPI 1336155894
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Desloge, MO
  • NPI 1336495373
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Saint Charles, MO
  • NPI 1346255361
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Bridgeton, MO
  • NPI 1346257359
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Blue Springs, MO
  • NPI 1356356372
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Saint Joseph, MO
  • NPI 1356356380
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Saint Charles, MO
  • NPI 1356357743
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Carthage, MO
  • NPI 1366457301
  NPD tax ID
• Walgreen Co

  • Pharmacy
  • Kansas City, MO
  • NPI 1366457392
  NPD tax ID

Member of 16

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

• Cypress Home Medical Inc

  • Home Infusion Therapy Pharmacy
  • Fort Myers, FL
  • NPI 1437188315

  Member Of

  NPD member
• Healthcare Options of Minnesota, Inc.

  • Home Infusion Therapy Pharmacy
  • Sauk Rapids, MN
  • NPI 1891746111

  Member Of

  NPD member
• I.V. Associates, Inc.

  • Home Infusion Therapy Pharmacy
  • Eatontown, NJ
  • NPI 1811940810

  Member Of

  NPD member
• Mednow Infusion, LLC

  • Home Infusion Agency
  • Meridian, ID
  • NPI 1225645526

  Member Of

  NPD member
• Option Care at Legacy Health LLC

  • Home Infusion Therapy Pharmacy
  • Bend, OR
  • NPI 1174875017

  Member Of

  NPD member
• Option Care Enterprises, Inc.

  • Home Infusion Therapy Pharmacy
  • Chantilly, VA
  • NPI 1679896989

  Member Of

  NPD member
• Option Care Home Care, Inc.

  • Home Infusion Agency
  • Wauwatosa, WI
  • NPI 1396343471

  Member Of

  NPD member
• Option Care Infusion Services, LLC

  • Home Infusion Therapy Pharmacy
  • Nashville, TN
  • NPI 1326279746

  Member Of

  NPD member
• TSL Inc

  • Home Infusion Therapy Pharmacy
  • Merrillville, IN
  • NPI 1942269956

  Member Of

  NPD member
• Walgreen Co

  • Pharmacy
  • Wilmington, DE
  • NPI 1093738643

  Member Of

  NPD member
• Walgreen Co

  • Pharmacy
  • Phoenix, AZ
  • NPI 1356356695

  Member Of

  NPD member
• Walgreen Co

  • Pharmacy
  • Rio Rancho, NM
  • NPI 1528073426

  Member Of

  NPD member

All facility ownership & control disclosures 77

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754611200000",
    "number": "1366544702",
    "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": "904 W BUSINESS US HIGHWAY 60",
            "city": "DEXTER",
            "state": "MO",
            "postal_code": "638412701",
            "telephone_number": "573-624-7452",
            "fax_number": "573-624-6867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN CO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-09-05",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "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": "MO",
            "license": "2017006071",
            "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": "NCPDP PROVIDER IDENTIFICATION NUMBER",
            "identifier": "2613443",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600307201",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #15800",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #15800",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ellen Vaughan, FNP
• Camellia A Vermillion, PMHNP
• Vincent H Coburn OD PC
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Emily Megan Ward
• Natasha Ware, MD
• James Larry Warren, NBC-HIS
• Larry Christopher Warren, H.I.S
• Angela Weiss, NP

• Pharmacy in Dexter, MO
• Providers in Dexter, MO by specialty
• Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.