WALGREEN EASTERN CO INC — NPI 1912422288 (Licensed & Credentialed Suppliers

CMS-1500 Box 24J / 33a • NPI

1912422288

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

333600000X (CMS 58)

Licensed & Credentialed Suppliers — Pharmacy

Box 32 Service Location & ZIP+4

151 MAPLE ST, CORNISH, ME, 04020-3103

✓ 9-Digit EDI 837 ZIP+4 (04020-3103)

Practice Phone & Referral Fax

(207) 625-8494

Fax: (207) 625-3880

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1912422288 (WALGREEN EASTERN CO INC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1912422288)

Medicare Beneficiaries

Total Billed Services

Distinct CPT/HCPCS Codes

Medicare Allowed Total

$3,282.57

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1912422288` (NPI-2 Organization / Facility)
Provider / Legal Name	WALGREEN EASTERN CO INC
Plain-English Specialty	Licensed & Credentialed Suppliers — Pharmacy NUCC Code: `333600000X` (Pharmacy)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	151 MAPLE ST, CORNISH, ME, 04020-3103
Practice Telephone / Fax	Tel: (207) 625-8494 \| Fax: (207) 625-3880
Administrative Mailing Address	1901 E VOORHEES ST, DANVILLE, IL, 61834-4515
Enumeration & Last Sync	Enumerated: 2017-08-08 \| CMS Record Updated: 2026-08-06
Authorized Official	JENNIFER PONCE (manager)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

151 MAPLE ST, CORNISH, ME, 04020-3103

🗺️ Open in Google Maps 🏥 More Providers in CORNISH

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Plain-English Taxonomy & CMS Crosswalk (333600000X)

What Does Taxonomy Code 333600000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 333600000X translates to:
"Licensed & Credentialed Suppliers — Pharmacy"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 58 (Medical Supply Company with Pharmacist) • CMS Code A5 (Pharmacy)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Pharmacy for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (WALGREEN EASTERN CO INC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`332BC3200X` — Durable Medical Equipment & Medical Supplies, Customized Equipment Plain English: Licensed & Credentialed Durable Medical Equipment & Medical Supplies, Customized Equipment	State: N/A \| License: `Verified` \| Primary: Secondary
`333600000X` — Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`3336C0003X` — Pharmacy, Community/Retail Pharmacy Plain English: Licensed & Credentialed Suppliers — Pharmacy, Community — Retail Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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WALGREEN EASTERN CO INC (NPI #1912422288)