Healthcare Provider Details

I. General information

NPI: 1376927699
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 10/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WILMOT RD MS 2140
DEERFIELD IL
60015-4620
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 224-323-5093
  • Fax:
Mailing address:
  • Phone: 217-709-2386
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number054.019551
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN A MANN
Title or Position: ASST SECRETARY
Credential:
Phone: 847-527-4640