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	183500000X	Pharmacist	RPH63422	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	183500000X-PHARMACIS	OTHER	CA	TAXONOMY

General Provider Information

NPI Number	:	1770852626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	121 LAMPLIGHTER
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92620-3834
Country	:	US
Telephone Number	:	714-595-8535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2627 PACIFIC AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2610
Country	:	US
Telephone Number	:	562-490-9575
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	AN T DINH
Credential	:	PHARM D
Telephone Number	:	714-595-8535

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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Directions to “WALGREENS ” Practice Location

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