Healthcare Provider Details

I. General information

NPI: 1992131569
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2013
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E ATKINS ST
DOBSON NC
27017-8700
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 336-386-4168
  • Fax: 336-386-4870
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
Identifier3462277
Identifier TypeOTHER
Identifier StateNC
Identifier IssuerNCPDP
# 2
Identifier1992131569
Identifier TypeMEDICAID
Identifier StateNC
Identifier Issuer

VIII. Authorized Official

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