Organization · Type 2 NPI

Walgreen Co

Pharmacy · Diberville, MS

NPI number 1972763092 Active

Practice location

12007 Lamey Bridge Rd
Diberville, MS 39540-8907

Call (228) 392-2388 Map

Fax (228) 392-6857

Mailing address

1901 E Voorhees St, Ms #790
Danville, IL 61834-4509

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Pharmacy Primary	333600000X	07822/01.2 (MS)
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 Diberville

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NPI record

NPI: 1972763092
Entity type: Organization (Type 2)
Issued: Jun 12, 2008
Last updated: Oct 12, 2026
Status: Active
Subpart: Yes of Walgreens Holding Company

Other names

<unavail>
Walgreens 10909 · doing business as
Walgreens 10909 · 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 1972763092

Walgreen Co's National Provider Identifier is 1972763092, issued on Jun 12, 2008. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Diberville, MS. The record was last updated on Oct 12, 2026.