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	302R00000X	Health Maintenance Organization	302R00000X	MN
2	302R00000X	Health Maintenance Organization	260525	MN

General Provider Information

NPI Number	:	1871879676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	475 NORTH ST
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55130-4418
Country	:	US
Telephone Number	:	651-757-5248
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 MARYLAND AVE W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-4528
Country	:	US
Telephone Number	:	651-487-3319
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MYIA M XIONG
Credential	:	RPH
Telephone Number	:	651-487-3319

Provider Enumeration Date	:	10/25/2011
Last Update Date	:	10/25/2011

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Directions to “WALGREENS ” Practice Location

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