Organization · Type 2 NPI

Walgreen Co

Pharmacy · Mangonia Park, FL

NPI number 1629692744 Active

Practice location

901 45th St
Mangonia Park, FL 33407-2413

Call (561) 402-8557 Map

Fax (561) 402-8558

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	None listed
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…

184 other providers at this address

NPI record

NPI: 1629692744
Entity type: Organization (Type 2)
Issued: Jun 4, 2020
Last updated: Nov 24, 2025
Status: Active
Subpart: Yes of Walgreens Boots Alliance Inc

Other names

<unavail>
Walgreens #21194 · doing business as
Walgreens #21194 · 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 1629692744

Walgreen Co's National Provider Identifier is 1629692744, issued on Jun 4, 2020. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Mangonia Park, FL. The record was last updated on Nov 24, 2025.