WALGREEN CO
NPI 1124033311
Pharmacy in Daytona Beach, FL

Active since July 29, 2006CLIA 10D2231462 · Waiver
100 S RIDGEWOOD AVE, DAYTONA BEACH, FL 32114(386) 255-4167 Get Directions Write a Review

NPPES record last updated: November 19, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 19, 2025, Apr 4, 2022, May 4, 2018 (3 updates tracked since 2018).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1124033311), doing business as Walgreens #04423, is a healthcare organization registered as a pharmacy in Daytona Beach, Florida and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through August 2, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1124033311
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address100 S RIDGEWOOD AVEDaytona Beach, FL 32114-4316
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Organization SubpartYesParent: Walgreens Boots Alliance Inc
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJuly 29, 2006
Last NPPES UpdateNovember 19, 20253 updates tracked since enumeration
NPPES CertifiedNovember 19, 2025
NPI 1124033311 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in FL · PH21353
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
100 S RIDGEWOOD AVE, Daytona Beach, FL 32114

Other Names 1

Doing Business AsWalgreens #04423

Other Identifiers 3

Medicaid030906101 DMEFL
Medicaid0309046100FL
Other1011357Other Id Number-commercial Number

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 10D2231462

Walgreen Co · Daytona Beach, FL
Active · expires Aug 2, 2027
CLIA Number10D2231462
Laboratory TypePharmacy
Certificate Effective DateAugust 3, 2025
Certificate Expiration DateAugust 2, 2027
Laboratory DirectorThomas R. Murphy Jr
Laboratory Phone(386) 255-4167
Laboratory LocationWalgreen Co100 S Ridgewood Ave, Daytona Beach, FL 32114
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 3

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.
52 services52 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.
25 services25 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.
22 services22 patients

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20369297
Accepts Medicare Assignment
YES
Specialities List
Pharmacy.
Competitive Bidding
NO

Supplies List

  • 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
  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device

Other Providers at the Same Location NPPES 2

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

Pharmacist
100 S RIDGEWOOD AVE
DAYTONA BEACH, FL 32114
Pharmacist
100 S RIDGEWOOD AVE
DAYTONA BEACH, FL 32114

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1124033311, enumerated as an "organization" on July 29, 2006.

The provider is located at 100 S RIDGEWOOD AVE DAYTONA BEACH, FL 32114 and the phone number is (386) 255-4167.

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.