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WALGREEN CO
NPI 1023431202
Pharmacy in Victorville, CA

Active since January 24, 2014CLIA 05D2307481 · Waiver
12184 PALMDALE RD, VICTORVILLE, CA 92392(760) 561-7009(760) 955-8025 Get Directions Write a Review

NPPES record last updated: June 10, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jun 25, 2025, Apr 8, 2022, Oct 10, 2018 and 2 more (5 updates tracked since 2015).

About Walgreen Co NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALGREEN CO (NPI 1023431202), doing business as Walgreens #12862, is a healthcare organization registered as a pharmacy in Victorville, California and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through July 8, 2028 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1023431202
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address12184 PALMDALE RDVictorville, CA 92392-8538
Mailing Address1901 E Voorhees St # Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Phone(760) 561-7009
Fax(760) 955-8025
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJanuary 24, 2014
Last NPPES UpdateJune 10, 20265 updates tracked since enumeration
NPPES CertifiedJune 10, 2026
✔ NPI 1023431202 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in CA · PHY51729
Definition
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 located.
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
Also ListedPharmacy · Community/Retail PharmacyTaxonomy 3336C0003X
12184 PALMDALE RD, Victorville, CA 92392
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Other Names 1

Doing Business AsWalgreens #12862

Other Identifiers 2

Other5650355CA · Ncpdp
Medicaid1023431202CA

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc., Ambetter from Absolute Total Care, Ambetter from Arkansas Health & Wellness and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D2307481

Walgreens 12862 · Victorville, CA
Active · expires Jul 8, 2028
CLIA Number05D2307481
Laboratory TypePharmacy
Certificate Effective DateJuly 9, 2026
Certificate Expiration DateJuly 8, 2028
Laboratory DirectorDavid C. Kistner
Laboratory Phone(760) 561-7009
Laboratory LocationWalgreens 1286212184 Palmdale Rd, Victorville, CA 92392
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
32 services32 patients
Influenza vaccine, inactivated 90653
The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.
17 services17 patients

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #12862 carries, from the Medicare DMEPOS supplier directory.

Walgreens #12862

DMEPOS supplier · Victorville, CAOperated by Walgreen Co
✔

Accepts Medicare assignment

Walgreens #12862 agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20385809
Medicare Participant SinceMarch 1, 2022
Supplier Location12184 Palmdale RdVictorville, CA 92392
Phone(760) 561-7009
Supplier Specialties
Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DANIEL CHINCHILLA
Pharmacist
12184 PALMDALE RD
VICTORVILLE, CA 92392
San Bernardino County (760) 561-7009

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1023431202. It was assigned to this organization in the NPPES registry on January 24, 2014. The provider is doing business as Walgreens #12862.

Where is Walgreen Co located?

Walgreen Co is located at 12184 Palmdale Rd, Victorville, CA 92392. The listed phone number is (760) 561-7009.

What is Walgreen Co's specialty?

The primary specialty registered for this NPI is Pharmacy with taxonomy code 333600000X.

Does Walgreen Co accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Walgreens #12862 accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Walgreen Co hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D2307481) is associated with this NPI, valid through July 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Walgreen Co accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 38 other insurers list Walgreen Co as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Walgreen Co was last updated on June 10, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 60 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.