MEDICARE: WALGREENS

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	261QH0100X	Health Service Clinic/Center	28RS00690300	NJ

General Provider Information

NPI Number	:	1144504911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	738 UNION AVE
Second Line	:
City	:	MIDDLESEX
State	:	NJ
Zip	:	08846-1941
Country	:	US
Telephone Number	:	973-559-0905
Fax Number	:	973-559-0078

Provider Business Practice Location Address
First Line	:	738 UNION AVE
Second Line	:
City	:	MIDDLESEX
State	:	NJ
Zip	:	08846-1941
Country	:	US
Telephone Number	:	973-559-0905
Fax Number	:	973-559-0078

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. KASHMIRA PATEL
Credential	:	RPH
Telephone Number	:	973-559-0905

Provider Enumeration Date	:	09/28/2011
Last Update Date	:	09/28/2011

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