WALGREEN CO
NPI 1306851324
Pharmacy in Mentor, OH

Q: What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1306851324. It was assigned to this organization in the NPPES registry on July 29, 2006. The provider is doing business as Walgreens #04317.

Q: What is Walgreen Co's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Walgreen Co was last updated on October 2, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months 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.

Active since July 29, 2006CLIA 36D2012209 · Waiver

9400 MENTOR AVE, MENTOR, OH 44060(440) 255-6247 Get Directions Write a Review

NPPES record last updated: October 2, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Walgreen Co NPPES

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

WALGREEN CO (NPI 1306851324), doing business as Walgreens #04317, is a healthcare organization registered as a pharmacy in Mentor, Ohio and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through October 12, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1306851324

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALGREEN CO

Location Address9400 MENTOR AVEMentor, OH 44060-4520

Mailing Address1901 E Voorhees St, Ms #790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344

Phone(440) 255-6247

Organization SubpartYesParent: Walgreens Boots Alliance Inc

Authorized OfficialJennifer PonceManager · (847) 527-2489

Enumeration DateJuly 29, 2006

Last NPPES UpdateOctober 2, 2025

NPPES CertifiedOctober 2, 2025

✔ NPI 1306851324 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in OH · 21051350

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

9400 MENTOR AVE, Mentor, OH 44060

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Other Names 1

Doing Business AsWalgreens #04317

Other Identifiers 2

Medicaid2041669OH

Other3664655Other Id Number-commercial Number

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 36D2012209

Walgreens #04317 · Mentor, OH

Active · expires Oct 12, 2027

CLIA Number36D2012209

Laboratory TypePharmacy

Certificate Effective DateOctober 13, 2025

Certificate Expiration DateOctober 12, 2027

Laboratory DirectorStephanie Roncalli

Laboratory Phone(440) 255-6247

Laboratory LocationWalgreens #043179400 Mentor Avenue, Mentor, OH 44060

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 6

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.

371 services365 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.

283 services283 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.

69 services69 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.

14 services14 patients

Influenza vaccine, quadrivalent inactivated, 0.5 ml dosage 90694

The quadrivalent inactivated influenza vaccine is a shot given to protect against four strains of the flu virus. This 0.5 ml dosage helps your body develop immunity to the virus. It's an important step in preventing flu-related complications.

13 services13 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.

11 services11 patients

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #4317 carries, from the Medicare DMEPOS supplier directory.

Walgreens #4317

DMEPOS supplier · Mentor, OHOperated by Walgreen Co

✔

Accepts Medicare assignment

Walgreens #4317 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)20391953

Medicare Participant SinceMarch 1, 2022

Supplier Location9400 Mentor AveMentor, OH 44060

Phone(440) 255-6247

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 9

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

JASON JOHNSON

Pharmacist