1972762680 NPI number — WALGREEN CO

Table of content: DR. JONATHAN BRADFORD THOENS M.D. (NPI 1861756223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972762680 NPI number — WALGREEN CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALGREEN CO
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972762680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 E VOORHEES ST
Provider Second Line Business Mailing Address:
MS 790
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61834-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-527-2489
Provider Business Mailing Address Fax Number:
217-709-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-3875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-524-3750
Provider Business Practice Location Address Fax Number:
303-524-3762
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PONCE
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
847-527-2489

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: PDO-37000045 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 50255550 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 494573 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0621044 . This is a "NCPDP" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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