Healthcare Provider Details

I. General information

NPI: 1720093628
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 CENTRAL AVE NE
ALBUQUERQUE NM
87108-1806
US

IV. Provider business mailing address

1901 E VOORHEES ST MAILSTOP #720
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 505-217-9907
  • Fax:
Mailing address:
  • Phone: 217-554-8964
  • Fax: 217-554-8546

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 NumberP1313
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KERMIT R. CRAWFORD
Title or Position: SR. VICE PRESIDENT
Credential:
Phone: 847-914-3154