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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 1972029650
Pharmacy in Ithaca, NY

Active since August 15, 2017CLIA 33D2240889 · Waiver
330 PINE TREE RD, ITHACA, NY 14850(607) 273-2035(607) 273-0316 Get Directions Write a Review

NPPES record last updated: June 24, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 12, 2025, Jun 9, 2022, Oct 18, 2019 and 4 more (7 updates tracked since 2017).

About Walgreen Co NPPES

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

WALGREEN CO (NPI 1972029650), doing business as Walgreens #19684, is a healthcare organization registered as a pharmacy in Ithaca, New York and active in the NPI registry since August 2017. The organization holds a CLIA Waiver certificate valid through March 26, 2027 and lists Jennifer Ponce, Manager, as its authorized official.

NPPES Registry Identity

NPI1972029650
Entity TypeOrganization
Primary Taxonomy333600000X
Legal Business NameWALGREEN CO
Location Address330 PINE TREE RDIthaca, NY 14850-2819
Mailing Address1901 E Voorhees St, Ms 790Danville, IL 61834-4509 · (847) 527-2489 · Fax (217) 709-2344
Phone(607) 273-2035
Fax(607) 273-0316
Organization SubpartYesParent: Walgreens Holding Company
Authorized OfficialJennifer PonceManager · (847) 527-2489
Enumeration DateAugust 15, 2017
Last NPPES UpdateJune 24, 20267 updates tracked since enumeration
NPPES CertifiedJune 24, 2026
✔ NPI 1972029650 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPharmacySuppliers
Taxonomy Code333600000X
License✔ Licensed in NY · 036261
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
330 PINE TREE RD, Ithaca, NY 14850
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Other Names 1

Doing Business AsWalgreens #19684

Other Identifiers 2

Other5823201NY · Ncpdp
Medicaid05020508NY

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 33D2240889

Walgreens No 19684 · Ithaca, NY
Active · expires Mar 26, 2027
CLIA Number33D2240889
Laboratory TypePharmacy
Certificate Effective DateOctober 22, 2021
Certificate Expiration DateMarch 26, 2027
Laboratory DirectorDr. Zeiad A. Fakhouri
Laboratory Phone(607) 273-2035
Laboratory LocationWalgreens No 19684330 Pine Tree Rd, Ithaca, NY 14850
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 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677
The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.
11 services11 patients
Administration of pneumococcal vaccine G0009
The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.
11 services11 patients

Other Providers at the Same Location NPPES 3

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

ERIN GRECO
Pharmacist
330 PINE TREE RD
ITHACA, NY 14850
Tompkins County (607) 273-2035
CHRISTOPHER DUY-ANH VU PHARMD
Pharmacist
330 PINE TREE RD
ITHACA, NY 14850
Tompkins County (607) 273-2035
DR. JESSICA LYNN DIBONA PHARMD
Pharmacist (Pharmacotherapy)
330 PINE TREE RD
ITHACA, NY 14850
Tompkins County (607) 273-2035

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 1972029650. It was assigned to this organization in the NPPES registry on August 15, 2017. The provider is doing business as Walgreens #19684.

Where is Walgreen Co located?

Walgreen Co is located at 330 Pine Tree Rd, Ithaca, NY 14850. The listed phone number is (607) 273-2035.

What is Walgreen Co's specialty?

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

Does Walgreen Co hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 33D2240889) is associated with this NPI, valid through March 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 39 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 June 24, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 45 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.