Healthcare Provider Details

I. General information

NPI: 1750559977
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 US HIGHWAY 84 E
CAIRO GA
39828-1852
US

IV. Provider business mailing address

1901 E VOORHEES ST MS #790
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 229-377-5510
  • Fax: 229-377-5515
Mailing address:
  • Phone: 217-709-2364
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE009477
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier795876151A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier795876151B
Identifier TypeOTHER
Identifier StateGA
Identifier IssuerMEDICAID DME
# 3
Identifier1156985
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP
# 4
Identifier008510800
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name: VIRGINIA GARZA
Title or Position: MANAGER
Credential:
Phone: 217-709-2364