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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 1760803035
Pharmacy in Fayetteville, AR

Active since January 03, 2014CLIA 04D2230693 · Waiver
4015 W WEDINGTON DR, FAYETTEVILLE, AR 72704(479) 442-2561(479) 442-2842 Get Directions Write a Review

NPPES record last updated: October 12, 2026. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 12, 2026, Sep 23, 2026, Apr 11, 2022 and 2 more (5 updates tracked since 2016).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1760803035), doing business as Walgreens #13118, is a healthcare organization registered as a pharmacy in Fayetteville, Arkansas and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through July 26, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1760803035
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address4015 W WEDINGTON DRFayetteville, AR 72704-5733
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Phone(479) 442-2561
Fax(479) 442-2842
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateJanuary 3, 2014
Last NPPES UpdateOctober 12, 20265 updates tracked since enumeration
NPPES CertifiedOctober 12, 2026
✔ NPI 1760803035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in AR · AR20741
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
4015 W WEDINGTON DR, Fayetteville, AR 72704
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Other Names 1

Doing Business AsWalgreens #13118

Other Identifiers 2

Other0424527AR · Ncpdp
Medicaid202259407AR

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 ›

Medicare Participation & PECOS CMS

Medicare enrollment and revalidation status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Walgreen Co is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by November 30, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateArkansasEnrollment IDO20140521000706DME · PharmacyDue dateNovember 30, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

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 04D2230693

Walgreens #13118 · Fayetteville, AR
Active · expires Jul 26, 2027
CLIA Number04D2230693
Laboratory TypePharmacy
Certificate Effective DateJuly 27, 2025
Certificate Expiration DateJuly 26, 2027
Laboratory DirectorRuby K. Brindley
Laboratory Phone(479) 442-2561
Laboratory LocationWalgreens #131184015 W Wedington Dr, Fayetteville, AR 72704
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

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

STEWART BRIDGER PD
Pharmacist
4015 W WEDINGTON DR
FAYETTEVILLE, AR 72704
Washington County (479) 442-2561
MINH CHU
Pharmacist
4015 W WEDINGTON DR
FAYETTEVILLE, AR 72704
Washington County (479) 442-2561
EVAN BRIAN PARKS PHARMD
Pharmacist
4015 W WEDINGTON DR
FAYETTEVILLE, AR 72704
Washington County (479) 442-2561
LINDSEY MCCLAIN PHARMD
Pharmacist
4015 W WEDINGTON DR
FAYETTEVILLE, AR 72704
Washington County (479) 442-2561
RACHEL TUCKER PHARMD
Pharmacist
4015 W WEDINGTON DR
FAYETTEVILLE, AR 72704
Washington County (479) 442-2561

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Walgreen Co's NPI number?

The NPI number for Walgreen Co is 1760803035. It was assigned to this organization in the NPPES registry on January 3, 2014. The provider is doing business as Walgreens #13118.

Where is Walgreen Co located?

Walgreen Co is located at 4015 W Wedington Dr, Fayetteville, AR 72704. The listed phone number is (479) 442-2561.

What is Walgreen Co's specialty?

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

Is Walgreen Co enrolled in Medicare?

Yes. Walgreen Co is registered in the Medicare PECOS enrollment system.

When is Walgreen Co's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (Arkansas, Pharmacy) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

Does Walgreen Co hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 04D2230693) is associated with this NPI, valid through July 26, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Walgreen Co accept?

Health plans from Alliant Health Plans, Inc., Ambetter Health, Ambetter Health of Delaware, Ambetter from Absolute Total Care and Ambetter from Arkansas Health & Wellness and 41 other insurers list Walgreen Co as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Walgreen Co was last updated on October 12, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.