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	3336C0003X	Community/Retail Pharmacy
2	291U00000X	Clinical Medical Laboratory
3	332B00000X	Durable Medical Equipment & Medical Supplies
4	333600000X	Pharmacy	22864	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4532847	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1568477628
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	:	4500 NORTH TARRANT PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4924
Country	:	US
Telephone Number	:	817-485-2547
Fax Number	:	817-428-8923

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

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	02/14/2023

Similar Medicare Providers

1457688764 — SHANNON ROGERS
Practice Location Address:

4500 N TARRANT PKWY
FORT WORTH, TX
76244-4924

Practice Phone: 817-485-2547
Practice Fax:

1972238293 — FRAME OF MIND LLC
Practice Location Address:

4924 CLIBURN DR
FORT WORTH, TX
76244

Practice Phone: 720-365-3026
Practice Fax:

1619970969 — DR. ROBERT J. ROGERS M.D.
Practice Location Address:

4200 S HULEN ST STE 230
FORT WORTH, TX
76109-4924

Practice Phone: 817-315-2550
Practice Fax: 817-732-4660

1396722583 — DR. SUSAN RUDD BAILEY M.D.
Practice Location Address:

4200 S HULEN ST STE 230
FORT WORTH, TX
76109-4924

Practice Phone: 817-315-2550
Practice Fax: 817-732-4660

1891848271 — DR. ANDREW DODSON BEATY M.D.
Practice Location Address:

4200 S HULEN ST STE 230
FORT WORTH, TX
76109-4924

Practice Phone: 817-315-2550
Practice Fax: 817-732-4660

1528230687 — DR. MILLARD LUCIEN TIERCE IV D.O.
Practice Location Address:

4200 S HULEN ST STE 230
FORT WORTH, TX
76109-4924

Practice Phone: 817-315-2550
Practice Fax: 817-732-4660

Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.