Healthcare Provider Details

I. General information

NPI: 1902323579
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MANLIUS ST
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 315-434-9178
  • Fax: 315-463-6952
Mailing address:
  • Phone: 217-709-2386
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number036180
License Number StateNY

VIII. Authorized Official

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