Healthcare Provider Details

I. General information

NPI: 1518276930
Provider Name (Legal Business Name): WALGREENS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2010
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NE BURNSIDE RD
GRESHAM OR
97030-7949
US

IV. Provider business mailing address

1950 NE BURNSIDE RD
GRESHAM OR
97030-7949
US

V. Phone/Fax

Practice location:
  • Phone: 503-674-8482
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0011211
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name: THUY-DUONG LE
Title or Position: PHARMACIST
Credential: PHARM.D
Phone: 503-674-8482