NPI age
18 years
Enumerated 2007-09-28
● Active Type 2 · Organization
Subpart
Walgreen Co
Walgreen Co is 1 of 961 pharmacy organizations in Georgia.
Primary specialty
Pharmacy
Plus 2 secondary
Practice locations
1
0 secondary on file
Status
Active
No deactivations on record
Authorized official
Ponce
Manager
Last NPPES update
2025-08-06
Source: monthly bulk 2026-05
How this organization compares
Across 961 active pharmacy providers in Georgia.
NPI age
18 years
≈ at median (18 yr)
Practice locations
1
0 secondary on file
Subspecialties
2
In the 80% of peers with subspecialties
NPI lifetime · 2007 → 2026
2007-09Enumerated in NPPES
2007
2026
Where they practice
Primary practice location
1081 Ga Highway 96
Warner Robins, GA 310882507
Mailing address
1901 E Voorhees St, MS #790
Danville, IL 618344515
Authorized official
Jennifer Ponce
Manager
📞 8475272489
Individual providers at this organization
7 individual providers on file at this primary practice address.
- Brandi Clark, PHARM.D. Pharmacist NPI 1306075502
- Matthew Crist, PHARMD Pharmacist NPI 1275879991
- Jocelyn Driver Pharmacist NPI 1215482104
- Jessica Miranda, PHARMD Pharmacist NPI 1306126891
- Parvin Mischel Pharmacist NPI 1801480272
- Jack Rumph, PHARMD Pharmacist NPI 1396990297
- Tanviben Wadiwala Pharmacist NPI 1467223834
Specialties
-
Pharmacy PrimaryA 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...
-
Durable Medical Equipment & Medical SuppliesA supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.
-
PharmacyA pharmacy where pharmacists store, prepare, and dispense medicinal preparations and/or prescriptions for a local patient population in accordance with federal and state law; counsel patients and caregivers (sometimes independent of the...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 05 (GA) | 618751852A | |
| 01 | 1156303 | NCPDP |
Other names on file (2)
Doing-business-as, former, and alternate names recorded by NPPES.
-
WALGREENS #10884
-
WALGREENS #10884
Practice context
Multi-provider organization. 7 individual providers on file at this primary address.
Subpart of Walgreens Boots Alliance Inc.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.