Healthcare Provider Details

I. General information

NPI: 1659513018
Provider Name (Legal Business Name): WALGREENS SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 ENTERPRISE DR
PITTSBURGH PA
15275-1213
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 888-347-3416
  • Fax: 877-231-8302
Mailing address:
  • Phone: 217-709-2386
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPP415372L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPP415372L
License Number StatePA

VIII. Authorized Official

Name: JENNIFER PONCE
Title or Position: MANAGER
Credential:
Phone: 847-527-2489