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	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	F-2630	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4026224	OTHER		NCPDP
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902079130
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	:	CARR 181, PLAZA ENCANTADA
Second Line	:	URB. ENCANTADA
City	:	TRUJILLO ALTO
State	:	PR
Zip	:	00976-0000
Country	:	US
Telephone Number	:	787-748-0013
Fax Number	:

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

Provider Enumeration Date	:	04/09/2008
Last Update Date	:	04/05/2022

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Directions to “WALGREEN CO. ” Practice Location

Language	Start Address	Practice Location

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