WALGREEN EASTERN CO INC
NPI 1104831288
Pharmacy in Queens Village, NY

Q: What is Walgreen Eastern Co Inc's NPI number?

The NPI number for Walgreen Eastern Co Inc is 1104831288. It was assigned to this organization in the NPPES registry on July 29, 2006. The provider is doing business as Walgreens #02055.

Q: What is Walgreen Eastern Co Inc's specialty?

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

Active since July 29, 2006CLIA 33D2295841 · Waiver

10962 FRANCIS LEWIS BLVD, QUEENS VILLAGE, NY 11429(718) 740-4612 Get Directions Write a Review

NPPES record last updated: June 15, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Oct 27, 2023, Feb 25, 2022, Dec 13, 2018 (3 updates tracked since 2018).

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About Walgreen Eastern Co Inc NPPES

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

WALGREEN EASTERN CO INC (NPI 1104831288), doing business as Walgreens #02055, is a healthcare organization registered as a pharmacy in Queens Village, New York and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Kira Taylor, Manager, as its authorized official.

NPPES Registry Identity

NPI1104831288

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALGREEN EASTERN CO INC

Location Address10962 FRANCIS LEWIS BLVDQueens Village, NY 11429-1723

Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (217) 709-2351 · Fax (217) 709-2344

Phone(718) 740-4612

Organization SubpartYesParent: Walgreens Holding Company

Authorized OfficialKira TaylorManager · (217) 709-2351

Enumeration DateJuly 29, 2006

Last NPPES UpdateJune 15, 20263 updates tracked since enumeration

NPPES CertifiedJune 15, 2026

✔ NPI 1104831288 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in NY · 20874

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

10962 FRANCIS LEWIS BLVD, Queens Village, NY 11429

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Other Names 1

Doing Business AsWalgreens #02055

Other Identifiers 2

Other3397987Other Id Number-commercial Number

Medicaid01230437NY

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 33D2295841

Walgreens No 02055 · Queens Village, NY

Active · expires Mar 26, 2027

CLIA Number33D2295841

Laboratory TypePharmacy

Certificate Effective DateDecember 18, 2023

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorDr. Zeiad A. Fakhouri

Laboratory Phone(718) 740-4612

Laboratory LocationWalgreens No 0205510962 Francis Lewis Blvd, Queens Village, NY 11429

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory to perform only waived tests.

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #2055 carries, from the Medicare DMEPOS supplier directory.

Walgreens #2055

DMEPOS supplier · Queens Village, NYOperated by Walgreen Eastern Co Inc

✔

Accepts Medicare assignment

Walgreens #2055 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)20338511

Medicare Participant SinceJanuary 1, 2023

Supplier Location10962 Francis Lewis BlvdQueens Village, NY 11429

Phone(718) 740-4988

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.

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Other Providers at the Same Location NPPES 12

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

DR. EBONY RHEM RPH

Pharmacist