Healthcare Provider Details

I. General information

NPI: 1891472403
Provider Name (Legal Business Name): WALGREEN CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2023
Last Update Date: 07/05/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 REES ST
BREAUX BRIDGE LA
70517-4514
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 337-332-6339
  • Fax:
Mailing address:
  • Phone: 217-709-2494
  • Fax:

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 Number
License Number State

VIII. Authorized Official

Name: KIRA L TAYLOR
Title or Position: MANAGER
Credential:
Phone: 217-709-2351