Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

WALGREEN CO
NPI 1477965002
Pharmacy in Brooklyn, NY

Q: What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1477965002. It was assigned to this organization in the NPPES registry on June 2, 2014. The provider is doing business as Walgreens #15097.

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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 59 days 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 June 02, 2014CLIA 33D2294122 · Waiver

589 PROSPECT AVE, BROOKLYN, NY 11215(347) 955-3029(347) 955-3064 Get Directions Write a Review

NPPES record last updated: June 16, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jan 12, 2026, Apr 26, 2022, Feb 7, 2019 (3 updates tracked since 2019).

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About Walgreen Co NPPES

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

WALGREEN CO (NPI 1477965002), doing business as Walgreens #15097, is a healthcare organization registered as a pharmacy in Brooklyn, New York and active in the NPI registry since June 2014. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1477965002

Entity TypeOrganization

Primary Taxonomy333600000X

Legal Business NameWALGREEN CO

Location Address589 PROSPECT AVEBrooklyn, NY 11215-6020

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

Phone(347) 955-3029

Fax(347) 955-3064

Organization SubpartYesParent: Walgreens Holding Company

Authorized OfficialJennifer PonceManager · (847) 527-2489

Enumeration DateJune 2, 2014

Last NPPES UpdateJune 16, 20263 updates tracked since enumeration

NPPES CertifiedJune 16, 2026

✔ NPI 1477965002 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers

Taxonomy Code333600000X

License✔ Licensed in NY · 032828

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

589 PROSPECT AVE, Brooklyn, NY 11215

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Other Names 1

Doing Business AsWalgreens #15097

Other Identifiers 2

Other5810797NY · Ncpdp

Medicaid04013645NY

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 33D2294122

Walgreens No 15097 · Brooklyn, NY

Active · expires Mar 26, 2027

CLIA Number33D2294122

Laboratory TypePharmacy

Certificate Effective DateNovember 20, 2023

Certificate Expiration DateMarch 26, 2027

Laboratory DirectorDr. Zeiad A. Fakhouri

Laboratory Phone(347) 955-3029

Laboratory LocationWalgreens No 15097589 Prospect Ave, Brooklyn, NY 11215

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 #15097 carries, from the Medicare DMEPOS supplier directory.

Walgreens #15097

DMEPOS supplier · Brooklyn, NYOperated by Walgreen Co

✔

Accepts Medicare assignment

Walgreens #15097 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)20387927

Medicare Participant SinceMarch 1, 2022

Supplier Location589 Prospect AveBrooklyn, NY 11215

Phone(347) 955-3029

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 9

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

MR. TAYLOR DIGGS MOSTELLER PHARMD

Pharmacist