WALGREENS MAIL SERVICE LLC

Provider Demographics

• NPI: 1164437406
• Name: WALGREENS MAIL SERVICE LLC
• Entity type: Organization
• Organization Name: WALGREENS MAIL SERVICE LLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: MANAGER
• Authorized Official - First Name: JENNIFER
• Authorized Official - Last Name: PONCE
• Authorized Official - Phone: 847-527-2489
• Mailing Address - Street 1: 1901 E VOORHEES ST
• Mailing Address - Street 2: MS 790
• Mailing Address - City: DANVILLE
• Mailing Address - State: IL
• Mailing Address - Zip Code: 61834-4509
• Mailing Address - Country: US
• Mailing Address - Phone: 217-709-2386
• Mailing Address - Fax: 217-709-2344
• Practice Address - Street 1: 8350 S RIVER PKWY
• Practice Address - City: TEMPE
• Practice Address - State: AZ
• Practice Address - Zip Code: 85284
• Practice Address - Country: US
• Practice Address - Phone: 480-752-1899
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: WALGREENS BOOTS ALLIANCE INC
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-07-29
• Last Update Date: 2024-12-03

Provider Licenses

State	License ID	Taxonomies
		332B00000X, 333600000X, 3336H0001X
AZ	Y007099	3336M0002X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	3336M0002X	Suppliers	Pharmacy	Mail Order Pharmacy
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	333600000X	Suppliers	Pharmacy
No	3336H0001X	Suppliers	Pharmacy	Home Infusion Therapy Pharmacy

Provider Identifiers

State	Identifier ID	ID Type	Issuer
	0320793	Other	NCPDP
PA	102121661-0002	Medicaid
AK	1581605	Medicaid
IN	200865090A	Medicaid
MN	287420100	Medicaid
TX	582061	Medicaid
HI	61792001	Medicaid
ID	807818000	Medicaid
WA	6031579	Medicaid
UT	1164437406	Medicaid
OK	200117370A	Medicaid
KS	200381070C	Medicaid
AZ	196411	Medicaid
	0320793	Other	OTHER ID NUMBER-COMMERCIAL NUMBER
VA	1164437406	Medicaid
OH	216526	Medicaid
MI	1164437406	Medicaid
IA	1164437406	Medicaid
NH	3096653	Medicaid
KY	7100491390	Medicaid
CA	1164437406	Medicaid
TN	1530581	Medicaid
NM	22120823	Medicaid
DC	28617386	Medicaid
HI	61792001	Medicaid