Organization · Type 2 NPI

Walgreen Co

Pharmacy · Detroit, MI

NPI number 1063883403 Active

Practice location

4501 Woodward Ave, Suite 105
Detroit, MI 48201-1890

Call (313) 230-2170 Map

Fax (312) 230-2004

Mailing address

1901 E Voorhees St # Ms 790
Danville, IL 61834-4515

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Pharmacy Primary	333600000X	5301010747 (MI)
Community/Retail Pharmacy	3336C0003X	None listed

Pharmacy: A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is lo…

2 other providers at this address

Other pharmacy providers in Detroit

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NPI record

NPI: 1063883403
Entity type: Organization (Type 2)
Issued: Oct 12, 2015
Last updated: Jun 3, 2026
Status: Active
Subpart: Yes of Walgreens Holding Company

Other names

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Walgreens Specialty Pharmacy #16374 · doing business as

Authorized official

Jennifer Ponce
Manager
(847) 527-2489

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1063883403

Walgreen Co's National Provider Identifier is 1063883403, issued on Oct 12, 2015. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Detroit, MI. The record was last updated on Jun 3, 2026.