MEDICARE: WALGREENS PHARMACY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	19193	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19193	OTHER	NV	NEVADA BOARD OF PHARMACY

General Provider Information

NPI Number	:	1053786749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS PHARMACY

Provider Business Mailing Address
First Line	:	PO BOX 80263
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89180-0263
Country	:	US
Telephone Number	:	440-452-5731
Fax Number	:

Provider Business Practice Location Address
First Line	:	5888 W SUNSET RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3453
Country	:	US
Telephone Number	:	702-585-2890
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	NICOLE LYNETTE MISKOV
Credential	:	PHARMD
Telephone Number	:	440-452-5731

Provider Enumeration Date	:	12/07/2015
Last Update Date	:	12/07/2015

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Directions to “WALGREENS PHARMACY ” Practice Location

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