Organization · Type 2 NPI

Walgreen Co

Pharmacy · Madera, CA

NPI number 1629214689 Active

Practice location

41169 Goodwin Way Ste 110
Madera, CA 93636-8766

Call (559) 353-6300 Map

Fax (559) 432-3475

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	PHY49849 (CA)
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…

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NPI record

NPI: 1629214689
Entity type: Organization (Type 2)
Issued: Dec 22, 2008
Last updated: Jun 10, 2026
Status: Active
Subpart: Yes of Walgreens Holding Company

Other names

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Walgreens Specialty Pharmacy #12761 · 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 1629214689

Walgreen Co's National Provider Identifier is 1629214689, issued on Dec 22, 2008. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Madera, CA. The record was last updated on Jun 10, 2026.