WALGREEN CO
NPI 1053326322
Pharmacy in Millbrae, CA

Active since July 29, 2006CLIA 05D2062652 · Waiver
615 BROADWAY, MILLBRAE, CA 94030(650) 697-0166 Get Directions Write a Review

NPPES record last updated: June 4, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 4, 2026, May 13, 2026, Oct 27, 2023 and 3 more (6 updates tracked since 2018).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1053326322), doing business as Walgreens #00625, is a healthcare organization registered as a pharmacy in Millbrae, California and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through June 26, 2028 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1053326322
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address615 BROADWAYMillbrae, CA 94030-1909
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJuly 29, 2006
Last NPPES UpdateJune 4, 20266 updates tracked since enumeration
NPPES CertifiedJune 4, 2026
NPI 1053326322 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in CA · PHY11991
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
615 BROADWAY, Millbrae, CA 94030

Other Names 1

Doing Business AsWalgreens #00625

Other Identifiers 2

Other0501494Other Id Number-commercial Number
Medicaid10533326322CA

Accepted 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 05D2062652

Walgreens #00625 · Millbrae, CA
Active · expires Jun 26, 2028
CLIA Number05D2062652
Laboratory TypePharmacy
Certificate Effective DateJune 27, 2026
Certificate Expiration DateJune 26, 2028
Laboratory DirectorTiffany G. Wong
Laboratory Phone(650) 697-0166
Laboratory LocationWalgreens #00625615 Broadway, Millbrae, CA 94030
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 5

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 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.
335 services333 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
268 services268 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.
56 services56 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
22 services22 patients
Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
19 services19 patients

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #625 carries, from the Medicare DMEPOS supplier directory.

Walgreens #625

DMEPOS supplier · Millbrae, CAOperated by Walgreen Co

Accepts Medicare assignment

Walgreens #625 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)20363495
Medicare Participant SinceMarch 1, 2022
Supplier Location615 BroadwayMillbrae, CA 94030
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 13

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

Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Pharmacist
615 BROADWAY
MILLBRAE, CA 94030
Clinic/Center
615 BROADWAY
MILLBRAE, CA 94030

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1053326322, enumerated as an "organization" on July 29, 2006.

The provider is located at 615 BROADWAY MILLBRAE, CA 94030 and the phone number is (650) 697-0166.

Pharmacy with taxonomy code 333600000X.

The provider might be accepting Accepts: Alliant Health Plans, Inc., Ambetter from Absolute. Please consult your insurance carrier or call the provider to verify.