Organization · Type 2 NPI

Walgreen Co

Pharmacy · Sparta, TN

NPI number 1649489089 Active

Practice location

483 W Bockman Way
Sparta, TN 38583-1832

Call (931) 836-3230 Map

Fax (931) 836-3241

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	4391 (TN)
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…

10 other providers at this address

Other pharmacy providers in Sparta

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NPI record

NPI: 1649489089
Entity type: Organization (Type 2)
Issued: May 22, 2007
Last updated: Oct 20, 2025
Status: Active
Subpart: Yes of Walgreens Boots Alliance Inc

Other names

<unavail>
Walgreens #10815 · doing business as
Walgreens #10815 · 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 1649489089

Walgreen Co's National Provider Identifier is 1649489089, issued on May 22, 2007. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Sparta, TN. The record was last updated on Oct 20, 2025.