Healthcare Provider Details

I. General information

NPI: 1679526974
Provider Name (Legal Business Name): WALGREENS SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 MOUNT KEMBLE AVE SUITE 300N
MORRISTOWN NJ
07960-6666
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 800-876-4545
  • Fax:
Mailing address:
  • Phone: 217-709-2386
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number28RS00656500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ALAN T NIELSEN
Title or Position: TREASURER
Credential:
Phone: 847-315-3523