Healthcare Provider Details

I. General information

NPI: 1467861633
Provider Name (Legal Business Name): WALGREENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 W CHEYENNE AVE
LAS VEGAS NV
89129-7262
US

IV. Provider business mailing address

8500 W CHEYENNE AVE
LAS VEGAS NV
89129-7262
US

V. Phone/Fax

Practice location:
  • Phone: 702-655-7258
  • Fax: 702-655-7295
Mailing address:
  • Phone: 702-655-7258
  • Fax: 702-655-7295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number18790
License Number StateNV

VIII. Authorized Official

Name: MELVIN WANG
Title or Position: PHARMACY MANAGER
Credential: PHARMD
Phone: 702-655-7258