Active NPI
Walgreen Eastern Co Inc
Doing business as Walgreens #04116
- Pharmacy
- Bethpage, NY
National Provider Identifier
1508871674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 23426
- Legal business name
- WALGREEN EASTERN CO INC
- Doing business as
- Walgreens #04116
- Practice address
- 4120 Hempstead Tpke
Bethpage, NY 11714-5600 - Phone
- (516) 520-8809
- Fax
- (516) 520-2958
- NPI assigned
- Jul 29, 2006
- Last updated
- Sep 24, 2026
- Organization subpart
- Yes
- Parent organization
- WALGREENS HOLDING COMPANY
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | ||
| Pharmacy | 333600000X | 23426 | NY | Primary |
| Community/Retail Pharmacy | 3336C0003X | NU |
Addresses
Primary practice location
4120 Hempstead Tpke
Bethpage, NY 11714-5600
Mailing address
1901 E Voorhees St
Ms 790
Danville, IL 61834-4515
Phone (847) 527-2489
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3329376 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 01777004 | Medicaid | NY |
Other names 1
- WALGREENS #04116
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, NY
Enrollment records 2
| 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 |
| O20100930051892 | NY | DME Supplier - Pharmacy | 7618929993 | Practice locations: Bethpage, NY |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 33D2296119 | Walgreens No 04116 | Certificate of waiver | Mar 26, 2027 |
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Walgreens #4116 | Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order) | Accepts assignment |
National Provider Directory
National Provider Directory- Tax ID family
- Walgreens Pharmacy 2267
- Part of
- Walgreens Holding Company
Organizations with this tax ID in the same state 21
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
-
- Pharmacy
- New Hartford, NY
- NPI 1558729491
Member of 3
Organizations this organization is a member of, according to the National Provider Directory.
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": "1790208000000",
"number": "1508871674",
"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": "4120 HEMPSTEAD TPKE",
"city": "BETHPAGE",
"state": "NY",
"postal_code": "117145600",
"telephone_number": "516-520-8809",
"fax_number": "516-520-2958"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN EASTERN CO INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREENS HOLDING COMPANY",
"enumeration_date": "2006-07-29",
"last_updated": "2026-09-24",
"certification_date": "2026-09-24",
"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": "NY",
"license": "23426",
"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": "3329376",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01777004",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WALGREENS #04116",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "WALGREENS #04116",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bethpage, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; 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.