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	3336C0003X	Community/Retail Pharmacy	123065	MN

General Provider Information

NPI Number	:	1750831723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	2724 GRAND AVE S
Second Line	:	APARTMENT 2
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55408-1407
Country	:	US
Telephone Number	:	636-279-0175
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 LYNDALE AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-3686
Country	:	US
Telephone Number	:	612-872-7808
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	DR. TROY PORTER
Credential	:
Telephone Number	:	636-279-0175

Provider Enumeration Date	:	10/13/2016
Last Update Date	:	10/13/2016

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