WALGREEN CO
NPI 1487669560
Pharmacy in East Patchogue, NY

Active since July 29, 2006CLIA 33D2226664 · Waiver
655 E MAIN ST, EAST PATCHOGUE, NY 11772(631) 447-6282 Get Directions Write a Review

NPPES record last updated: June 16, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Sep 8, 2025, Apr 12, 2022, Jan 25, 2019 (3 updates tracked since 2019).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1487669560), doing business as Walgreens #13643, is a healthcare organization registered as a pharmacy in East Patchogue, 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 Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1487669560
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address655 E MAIN STEast Patchogue, NY 11772-3152
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJuly 29, 2006
Last NPPES UpdateJune 16, 20263 updates tracked since enumeration
NPPES CertifiedJune 16, 2026
NPI 1487669560 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in NY · 20611
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 E MAIN ST, East Patchogue, NY 11772

Other Names 1

Doing Business AsWalgreens #13643

Other Identifiers 2

Other3396202Other Id Number-commercial Number
Medicaid01196730NY

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 33D2226664

Walgreens No 13643 · East Patchogue, NY
Active · expires Mar 26, 2027
CLIA Number33D2226664
Laboratory TypePharmacy
Certificate Effective DateJune 2, 2021
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Zeiad Fakhouri
Laboratory Phone(631) 447-6282
Laboratory LocationWalgreens No 13643655 E Main St, East Patchogue, NY 11772
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

The provider carries the following medical supplies product categories:

PTAN
20385803
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

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

Pharmacist
655 E MAIN ST
EAST PATCHOGUE, NY 11772

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1487669560, enumerated as an "organization" on July 29, 2006.

The provider is located at 655 E MAIN ST EAST PATCHOGUE, NY 11772 and the phone number is (631) 447-6282.

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.