WALGREEN CO
NPI 1770816704
Pharmacy in Portland, ME

Active since September 09, 2009CLIA 20D2200377 · Waiver
616 FOREST AVE, PORTLAND, ME 04101(207) 761-9454(207) 761-9462 Get Directions Write a Review

NPPES record last updated: June 2, 2026. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 2, 2026, May 12, 2026, Jan 14, 2026 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 1770816704), doing business as Walgreens #12325, is a healthcare organization registered as a pharmacy in Portland, Maine and active in the NPI registry since September 2009. The organization holds a CLIA Waiver certificate valid through November 15, 2026 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1770816704
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address616 FOREST AVEPortland, ME 04101-1510
Mailing Address1901 E Voorhees StDanville, IL 61834-4515 · (217) 709-2364 · Fax (217) 709-2344
Fax(207) 761-9462
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (224) 475-5702
Enumeration DateSeptember 9, 2009
Last NPPES UpdateJune 2, 20265 updates tracked since enumeration
NPPES CertifiedJune 2, 2026
NPI 1770816704 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License Licensed in ME · PH50001390
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
616 FOREST AVE, Portland, ME 04101

Other Names 1

Doing Business AsWalgreens #12325

Other Identifiers 1

Other2008426Ncpdp

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 20D2200377

Walgreens #12325 · Portland, ME
Active · expires Nov 15, 2026
CLIA Number20D2200377
Laboratory TypePharmacy
Certificate Effective DateNovember 16, 2024
Certificate Expiration DateNovember 15, 2026
Laboratory DirectorSanchu Thomas
Laboratory Phone(207) 761-9454
Laboratory LocationWalgreens #12325616 Forest Ave, Portland, ME 04101
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 3

Services this provider delivered to Medicare fee-for-service patients, from the 2024 & 2026 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.
97 services96 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.
62 services62 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.
23 services23 patients

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Walgreens #12325 carries, from the Medicare DMEPOS supplier directory.

Walgreens #12325

DMEPOS supplier · Portland, MEOperated by Walgreen Co

Accepts Medicare assignment

Walgreens #12325 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)20378555
Medicare Participant SinceMarch 1, 2022
Supplier Location616 Forest AvePortland, ME 04101
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.

Dietitian, Registered
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101
Pharmacist
616 FOREST AVE
PORTLAND, ME 04101

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1770816704, enumerated as an "organization" on September 09, 2009.

The provider is located at 616 FOREST AVE PORTLAND, ME 04101 and the phone number is (207) 761-9454.

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.