NPIMap

Organization Active NPI

Walgreen Eastern Co Inc

  • Pharmacy
  • Willimantic, CT
National Provider Identifier
1912912262
Registry record updated Jun 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
960 Issued in CT
Legal business name
WALGREEN EASTERN CO INC
Practice address
1475 Main St
Willimantic, CT 06226-1914
Phone
(860) 423-6304
NPI assigned
Jul 29, 2006
Organization subpart
Yes
Parent organization
WALGREENS BOOTS ALLIANCE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 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
Pharmacy 333600000X 960 CT Primary
Community/Retail Pharmacy 3336C0003X

Addresses

Primary practice location

1475 Main St
Willimantic, CT 06226-1914

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
0711906OtherOTHER ID NUMBER-COMMERCIAL NUMBER
004068250MedicaidCT
004109155 DMEMedicaidCT

Other names 1

  • WALGREENS #07333 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, CT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20071211000174 TX Part B Supplier - Centralized Flu Biller 7618929993 This NPI is an additional NPI on the enrollment
O20100930010729 CT DME Supplier - Pharmacy 7618929993 Practice locations: Willimantic, CT
O20210125001959 CT Part B Supplier - Independent Clinical Laboratory 7618929993 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Willimantic, CT; Wethersfield, CT; North Haven, CT; Middletown, CT; Waterbury, CT

Other NPIs on the same Medicare enrollment 6

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

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
07D2241776Walgreens # 073331475 Main St, Willimantic, CT 06226Certificate of waiverNov 1, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Walgreen Eastern Co Inc1475 Main St, Willimantic, CT 06226-1914(860) 423-6304 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
Walgreens Pharmacy 1869338 organizations share this tax ID, including this one
Part of
Walgreens Holding Company

Organizations with this tax ID in the same state 5

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

Member of 3

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

Locations

1475 Main St
Willimantic, CT 06226
Phone (860) 423-6304

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1750723200000",
    "number": "1912912262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 E VOORHEES ST # 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": "1475 MAIN ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062261914",
            "telephone_number": "860-423-6304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREEN EASTERN CO INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALGREENS BOOTS ALLIANCE INC",
        "enumeration_date": "2006-07-29",
        "last_updated": "2025-06-24",
        "certification_date": "2025-06-24",
        "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": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "CT",
            "license": "960",
            "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": "OTHER ID NUMBER-COMMERCIAL NUMBER",
            "identifier": "0711906",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004068250",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004109155 DME",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WALGREENS #07333",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WALGREENS #07333",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Willimantic, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 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.