NPIMap

Organization Active NPI

Walgreen Louisiana Co Inc

Doing business as Walgreens #04566

  • Pharmacy
  • Lafayette, LA
National Provider Identifier
1407861677
Registry record updated Mar 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
4057RC Issued in LA
Legal business name
WALGREEN LOUISIANA CO INC
Doing business as
Walgreens #04566
Practice address
2700 Johnston St
Lafayette, LA 70503-3242
Phone
(337) 232-9317
NPI assigned
Jul 29, 2006
Last updated
Mar 27, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2025

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 4057RC LA Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

2700 Johnston St
Lafayette, LA 70503-3242

Mailing address

1901 E Voorhees St
Mailstop #790
Danville, IL 61834-4509
Phone (847) 527-2489

Other identifiers 3

IdentifierTypeStateIssuer
1928122OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1266329MedicaidLA
690014MedicaidTX

Other names 1

  • WALGREENS #04566 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, LA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20091007000225 TX Part B Supplier - Centralized Flu Biller 5799821690 25 other NPIs on this enrollment
Practice locations: New Orleans, LA; Shreveport, LA; Slidell, LA; Thibodaux, LA; Baton Rouge, LA; Hammond, LA; Harvey, LA; Kenner, LA…
O20100930001393 LA DME Supplier - Pharmacy 5799821690 Practice locations: Lafayette, LA
O20221201002505 LA Part B Supplier - Independent Clinical Laboratory 5799821690 14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Baton Rouge, LA; Slidell, LA; Shreveport, LA; New Orleans, LA; Lake Charles, LA; Lafayette, LA; Kenner, LA; Harvey, LA

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 24

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 24

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
19D2015512Walgreens #045662700 Johnston St, Lafayette, LA 70503Certificate of waiverMay 31, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walgreens #045662700 Johnston St, Lafayette, LA 70503-3242(337) 232-9317 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
Walgreen Louisiana Co Inc20 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Member of 1

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

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

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": "1743033600000",
    "number": "1407861677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST",
            "address_2": "MAILSTOP #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": "2700 JOHNSTON ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705033242",
            "telephone_number": "337-232-9317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN LOUISIANA CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-07-29",
        "last_updated": "2025-03-27",
        "certification_date": "2025-03-27",
        "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": "LA",
            "license": "4057RC",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "1928122",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1266329",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690014",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #04566",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #04566",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2025; 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.