Healthcare Provider Details

I. General information

NPI: 1528255726
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1816 FRANKLIN STREET
MICHIGAN CITY IN
46360-4504
US

IV. Provider business mailing address

1901 E VOORHEES ST MAIL STOP #720
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-8105
  • Fax:
Mailing address:
  • Phone: 217-554-8494
  • Fax: 217-554-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. KERMIT R CRAWFORD
Title or Position: CORP. VICE PRESIDENT
Credential:
Phone: 847-914-3159