Walgreens #12360 – Pharmacy, NPI 1629223631

Walgreens #12360 is a healthcare provider. based in Danville, Illinois. specializing in Pharmacy. The organization holds a License No. 0201004265 (VA). The NPI Number for Walgreens #12360 is 1629223631

Main info

Organization
Name
Walgreens #12360
NPI
1629223631
Phone
(847) 527-2489
Address
1901 E VOORHEES ST
Authorized Official
JENNIFER PONCE MANAGER
Enumeration Date
19 November 2008
Last Update Date
21 October 2025
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience68
Completeness90
Years active:17State licenses:1Digital endpoints

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Provider Addresses for Walgreens #12360

  • 1901, East Voorhees Street, Danville, Vermilion County, Illinois, 61832, United States

    MS #790

    DANVILLE, IL 618344515

    Phone: (847) 527-2489

    Fax: (217) 709-2344

    Type: Mailing

  • 3901, Oaklawn Boulevard, Jefferson Park, Hopewell City, Prince George County, Virginia, 23860, United States

    HOPEWELL, VA 238605509

    Phone: (804) 452-2542

    Fax: (804) 453-5134

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2010-09-30

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2025-11-30 (196 days ago).

Enrollment records

1

Earliest due date

2025-11-30

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20100930011835OPharmacyVA2025-11-30

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
K1034Provision of covid-19 test, nonprescription self-administered and self-collected use, fda approved, authorized or cleared, one test count36845$0
G0008Administration of influenza virus vaccine235235$0
91320Sarscv2 vac 30mcg trs-suc im165165$0
90480Admn sarscov2 vacc 1 dose165165$0
90662Influenza vaccine split virus, preservative free157157$0
View full utilization report →

Insurance plans in this area (ZIP 61834)

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Reviews

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Frequently asked questions

Is Walgreens #12360 listed with a National Provider Identifier?
Yes — Walgreens #12360 has NPI 1629223631 on file in the registry.
Is there an active status for Walgreens #12360?
For scheduling context, Walgreens #12360 is shown as active in the registry.
What clinical focus is listed for Walgreens #12360?
At a glance, Walgreens #12360 is tied to Pharmacy. Clinical services aligned with this taxonomy classification.
What practice footprint exists for Walgreens #12360?
Travel planning: use Danville, Illinois as the reference point for Walgreens #12360, then confirm.
When was this NPI issued?
Enumeration for Walgreens #12360 is noted as November 19, 2008 where the registry provides it.

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