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	52017	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122746891	OTHER	CA	PHARMACIST

General Provider Information

NPI Number	:	1932482429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	2105 MORRILL AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-1130
Country	:	US
Telephone Number	:	408-263-5550
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 MORRILL AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95132-1130
Country	:	US
Telephone Number	:	408-263-5550
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	FRANCES TAN
Credential	:
Telephone Number	:	408-263-5550

Provider Enumeration Date	:	09/21/2011
Last Update Date	:	09/21/2011

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Directions to “WALGREENS ” Practice Location

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