Healthcare Provider Details

I. General information

NPI: 1346424389
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 419-221-0166
  • Fax:
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 Number02-180660001329
License Number StateOH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007516640011
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier7100365310
Identifier TypeMEDICAID
Identifier StateKY
Identifier Issuer
# 3
Identifier2817947
Identifier TypeMEDICAID
Identifier StateOH
Identifier Issuer
# 4
Identifier201299770A
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer
# 5
Identifier3676612
Identifier TypeOTHER
Identifier State
Identifier IssuerNCPDP

VIII. Authorized Official

Name: ALYSSA SWEETEN
Title or Position: MANAGER
Credential:
Phone: 217-709-2386