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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 1912172529
Pharmacy in Lake Buena Vista, FL

Active since April 24, 2008CLIA 10D2137401 · Waiver
960 BACK STAGE LN, LAKE BUENA VISTA, FL 32830(407) 934-2030(407) 934-2031 Get Directions Write a Review

NPPES record last updated: October 20, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Apr 11, 2022, May 9, 2018 (2 updates tracked since 2018).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1912172529), doing business as Center For Living Well Family Health Care, is a healthcare organization registered as a pharmacy in Lake Buena Vista, Florida and active in the NPI registry since April 2008. The organization holds a CLIA Waiver certificate valid through September 25, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1912172529
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address960 BACK STAGE LNLake Buena Vista, FL 32830-8472
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4515 · (847) 527-2489 · Fax (217) 709-2344
Phone(407) 934-2030
Fax(407) 934-2031
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateApril 24, 2008
Last NPPES UpdateOctober 20, 20262 updates tracked since enumeration
NPPES CertifiedOctober 20, 2026
✔ NPI 1912172529 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in FL · PH23619
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
960 BACK STAGE LN, Lake Buena Vista, FL 32830
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Other Names 1

Doing Business AsCenter For Living Well Family Health Care

Other Identifiers 3

Medicaid002683800FL
Other002683801FL · Medicaid Dme
Other1037212Ncpdp

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 December 31, 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
StateFloridaEnrollment IDO20100930016345DME · PharmacyDue dateDecember 31, 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 10D2137401

Walgreen Co Dba Center For Living Well Family Health Care Pharmacy · Orlando, FL
Active · expires Sep 25, 2027
CLIA Number10D2137401
Laboratory TypePharmacy
Certificate Effective DateSeptember 26, 2025
Certificate Expiration DateSeptember 25, 2027
Laboratory DirectorJason C. Hunkele
Laboratory Phone(407) 934-2030
Laboratory LocationWalgreen Co Dba Center For Living Well Family Health Care Pharmacy960 Back Stage Lane, Orlando, FL 32830
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

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

AMBER Y SHEPARD M.D.
Family Medicine
960 BACK STAGE LN
ORLANDO, FL 32830
Orange County (407) 934-4100
SARAH SUMRALL PA-C
Physician Assistant
960 BACK STAGE LN
LAKE BUENA VISTA, FL 32830
Orange County (407) 934-4100
DR. JEFFREY THOMAS NELSON D.O.
Family Medicine
960 BACK STAGE LN
LAKE BUENA VISTA, FL 32830
Orange County (407) 934-4100
DANIELLE BOHRER
Pharmacist
960 BACK STAGE LN
LAKE BUENA VISTA, FL 32830
Orange County (407) 934-2030
DR. LISA CLAYVILLE MARTIN PHARMD
Pharmacist
960 BACK STAGE LN
LAKE BUENA VISTA, FL 32830
Orange County (407) 934-2505
MRS. MICHELLE ADRIANA FLORES PA-C
Physician Assistant
960 BACK STAGE LN
ORLANDO, FL 32830
Orange County (407) 934-4100
DR. MICHELLE LYNNETTE HALL M.D.
Family Medicine
960 BACK STAGE LN
LAKE BUENA VISTA, FL 32830
Orange County (407) 934-4100
DR. JUSTINE MARIE TRAN PHARM.D.
Pharmacist
960 BACK STAGE LN
LAKE BUENA VISTA, FL 32830
Orange County (407) 934-2030

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 1912172529. It was assigned to this organization in the NPPES registry on April 24, 2008. The provider is doing business as Center for Living Well Family Health Care.

Where is Walgreen Co located?

Walgreen Co is located at 960 Back Stage Ln, Lake Buena Vista, FL 32830. The listed phone number is (407) 934-2030.

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 (Florida, Pharmacy) is due for revalidation by December 31, 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 10D2137401) is associated with this NPI, valid through September 25, 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 38 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 20, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.