Healthcare Provider Details

I. General information

NPI: 1245756469
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 CHINA RD
WINSLOW ME
04901-7246
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 207-872-2727
  • Fax: 207-873-4793
Mailing address:
  • Phone: 217-709-2351
  • 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 TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier1245756469
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer
# 2
IdentifierPH50001606
Identifier TypeOTHER
Identifier StateME
Identifier IssuerBOARD OF PHARMACY

VIII. Authorized Official

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