MEDICARE: WALGREEN CO

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0002X	Clinic Pharmacy
3	333600000X	Pharmacy	8801-042	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	5130290	OTHER		NCPDP

General Provider Information

NPI Number	:	1164603403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MS #790
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	217-709-2351
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	1979 LIME KILN RD
Second Line	:
City	:	BELLEVUE
State	:	WI
Zip	:	54311-6219
Country	:	US
Telephone Number	:	920-288-0638
Fax Number	:	920-288-0645

Authorized Official
Title or Position	:	MANAGER
Name	:	KIRA TAYLOR
Credential	:
Telephone Number	:	217-709-2351

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	10/30/2023

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Directions to “WALGREEN CO ” Practice Location

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