Healthcare Provider Details

I. General information

NPI: 1013187384
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6300 CRAIN HWY
LA PLATA MD
20646-4259
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-392-6116
  • Fax: 301-392-1544
Mailing address:
  • Phone: 217-709-2364
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberP06764
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

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