Active NPI
Walgreen Eastern Co Inc
- Pharmacy
- Providence, RI
National Provider Identifier
1891702841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- License
- 7979
- Legal business name
- WALGREEN EASTERN CO INC
- Practice address
- 354 Admiral St
Providence, RI 02908-2537 - Phone
- (401) 331-2636
- NPI assigned
- Aug 2, 2006
- Organization subpart
- Yes
- Parent organization
- WALGREENS BOOTS ALLIANCE INC
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 | |||
| Pharmacy | 333600000X | 7979 | RI | Primary |
| Community/Retail Pharmacy | 3336C0003X |
Addresses
Primary practice location
354 Admiral St
Providence, RI 02908-2537
Mailing address
1901 E Voorhees St # Ms 790
Danville, IL 61834-4515
Phone (847) 527-2489
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1670166 DME | Medicaid | RI | |
| WE20110 | Medicaid | RI | |
| 4105652 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER |
Other names 1
- WALGREENS #03703
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, RI
Enrollment records 3
| 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 |
| O20210122001576 | RI | Part B Supplier - Independent Clinical Laboratory | 0941278253 |
27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Coventry, RI; West Warwick, RI; Warwick, RI; Tiverton, RI; Rumford, RI; Richmond, RI; Providence, RI; North Scituate, RI… |
| O20210125002901 | RI | Part B Supplier - Independent Clinical Laboratory | 7618929993 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Middletown, RI; North Providence, RI; Pawtucket, RI; Providence, RI; Woonsocket, RI; Johnston, RI |
Other NPIs on the same Medicare enrollment 30
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- Walgreens Holding Company
Member of 3
Organizations this organization is a member of, according to the National Provider Directory.
Locations
354 Admiral St
Providence, RI 02908
Phone (401) 331-2636
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Pharmacist
- Providence, RI
- NPI 1902189939
-
- Pharmacist
- Providence, RI
- NPI 1841801404
-
- Pharmacist
- Providence, RI
- NPI 1366727919
-
- Pharmacist
- Providence, RI
- NPI 1699059196
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1750032000000",
"number": "1891702841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1901 E VOORHEES ST # 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": "354 ADMIRAL ST",
"city": "PROVIDENCE",
"state": "RI",
"postal_code": "029082537",
"telephone_number": "401-331-2636"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WALGREEN EASTERN CO INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
"enumeration_date": "2006-08-02",
"last_updated": "2025-06-16",
"certification_date": "2025-06-16",
"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": "RI",
"license": "7979",
"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": "1670166 DME",
"state": "RI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "WE20110",
"state": "RI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OTHER ID NUMBER-COMMERCIAL NUMBER",
"identifier": "4105652",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "WALGREENS #03703",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "WALGREENS #03703",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Providence, RI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; 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.