NPIMap

Organization Active NPI

Walgreen Louisiana Co Inc

Doing business as Walgreens #06219

  • Pharmacy
  • Lake Charles, LA
National Provider Identifier
1629084017
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
1166RC Issued in LA
Legal business name
WALGREEN LOUISIANA CO INC
Doing business as
Walgreens #06219
Practice address
2636 Ryan St
Lake Charles, LA 70601-7326
Phone
(337) 433-4178
NPI assigned
Jul 31, 2006
Last updated
Feb 10, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 10, 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 NU
Pharmacy 333600000X 1166RC LA Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

2636 Ryan St
Lake Charles, LA 70601-7326

Mailing address

1901 E Voorhees St
Ms 790
Danville, IL 61834-4515
Phone (847) 527-2489

Other identifiers 3

IdentifierTypeStateIssuer
1900302OtherOTHER ID NUMBER-COMMERCIAL NUMBER
1242837MedicaidLA
690015MedicaidTX

Other names 1

  • WALGREENS #06219 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
This NPI is an additional NPI on the enrollment
Practice locations: New Orleans, LA; Shreveport, LA; Slidell, LA; Thibodaux, LA; Baton Rouge, LA; Hammond, LA; Harvey, LA; Kenner, LA…
O20100930069762 LA DME Supplier - Pharmacy 5799821690 Practice locations: Lake Charles, 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
19D2015516Walgreens # 062192636 Ryan St, Lake Charles, LA 70601Certificate of waiverApr 15, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walgreens #062192636 Ryan St, Lake Charles, LA 70601-7326(337) 433-4178 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.

Locations (25 of 32)

11297 Florida Blvd
Baton Rouge, LA 70815
Phone (225) 272-9769

11297 Florida Blvd
#2996
Baton Rouge, LA 70815
Phone (225) 272-9769

5450 Plank Rd
Baton Rouge, LA 70805
Phone (225) 355-9782

5450 Plank Rd
#2982
Baton Rouge, LA 70805
Phone (225) 355-9782

1910 W Thomas St
Hammond, LA 70401
Phone (985) 345-1600

1556 Lapalco Blvd
#3156
Harvey, LA 70058
Phone (504) 367-9461

821 W Esplanade Ave
Kenner, LA 70065
Phone (504) 468-5479

821 W Esplanade Ave
#5472
Kenner, LA 70065
Phone (504) 468-5479

2700 Johnston St
Lafayette, LA 70503
Phone (337) 232-3664

2700 Johnston St
#4566
Lafayette, LA 70503
Phone (337) 232-9317

1106 N Martin Luther King Hwy
Lake Charles, LA 70601
Phone (337) 436-7833

2636 Ryan St
Lake Charles, LA 70601
Phone (337) 433-4178

2636 Ryan St
#6219
Lake Charles, LA 70601
Phone (337) 433-4178

1100 Elysian Fields Ave
#2262
New Orleans, LA 70117
Phone (504) 943-9788

1801 Saint Charles Ave
#5040
New Orleans, LA 70130
Phone (504) 561-8458

1826 N Broad St
New Orleans, LA 70119
Phone (504) 944-7932

1826 N Broad St
#3139
New Orleans, LA 70119
Phone (504) 944-7932

3227 Magazine St
New Orleans, LA 70115
Phone (504) 899-2610

3227 Magazine St
#2640
New Orleans, LA 70115
Phone (504) 899-2610

4110 General Degaulle Dr
#3889
New Orleans, LA 70131
Phone (504) 433-3297

4400 S Claiborne Ave
New Orleans, LA 70125
Phone (504) 891-0975

4400 S Claiborne Ave
#4451
New Orleans, LA 70125
Phone (504) 891-0976

5501 Crowder Blvd
New Orleans, LA 70127
Phone (504) 241-1456

5702 Crowder Blvd
New Orleans, LA 70127
Phone (504) 241-1456

10009 Jefferson Hwy
River Ridge, LA 70123
Phone (504) 737-2111

Practitioners & affiliated clinicians

Practitioners 136

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 136

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770681600000",
    "number": "1629084017",
    "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": "2636 RYAN ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706017326",
            "telephone_number": "337-433-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN LOUISIANA CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-07-31",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "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": "1166RC",
            "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": "1900302",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1242837",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "690015",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #06219",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #06219",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Charles, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.

Verify at the official NPI Registry.