WALGREEN CO
NPI 1386990323
Pharmacy in Staten Island, NY

Q: What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1386990323. It was assigned to this organization in the NPPES registry on July 27, 2012. The provider is doing business as Walgreens #15160.

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 June 16, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 27, 2012CLIA 33D2226513 · Waiver

655 ROSSVILLE AVE, STATEN ISLAND, NY 10309(718) 967-2955(718) 967-2978 Get Directions Write a Review

NPPES record last updated: June 16, 2026. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 25, 2025, Apr 26, 2022, Feb 7, 2019 and 2 more (5 updates tracked since 2017).

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About Walgreen Co NPPES

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

WALGREEN CO (NPI 1386990323), doing business as Walgreens #15160, is a healthcare organization registered as a pharmacy in Staten Island, New York and active in the NPI registry since July 2012. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1386990323

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALGREEN CO

Location Address655 ROSSVILLE AVEStaten Island, NY 10309-1718

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

Phone(718) 967-2955

Fax(718) 967-2978

Organization SubpartYesParent: Walgreens Holding Company

Authorized OfficialJennifer PonceManager · (847) 527-2489

Enumeration DateJuly 27, 2012

Last NPPES UpdateJune 16, 20265 updates tracked since enumeration

NPPES CertifiedJune 16, 2026

✔ NPI 1386990323 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in NY · 031561

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

655 ROSSVILLE AVE, Staten Island, NY 10309

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Other Names 1

Doing Business AsWalgreens #15160

Other Identifiers 2

Other5805998NY · Ncpdp

Medicaid03547353NY

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 33D2226513

Walgreens #15160 · Staten Island, NY

Active · expires Mar 26, 2027

CLIA Number33D2226513

Laboratory TypePharmacy

Certificate Effective DateJune 1, 2021

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorDr. Zeiad Fakhouri

Laboratory Phone(718) 967-2955

Laboratory LocationWalgreens #15160655 Rossville Ave, Staten Island, NY 10309

CLIA data matches this NPI record on: Address Name 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 #15160 carries, from the Medicare DMEPOS supplier directory.

Walgreens #15160

DMEPOS supplier · Staten Island, NYOperated by Walgreen Co

✔

Accepts Medicare assignment

Walgreens #15160 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)20384681

Medicare Participant SinceMarch 1, 2022

Supplier Location655 Rossville AveStaten Island, NY 10309

Phone(718) 967-2955

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 8

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

ANGELISE HICKS

Pharmacist