Healthcare Provider Details

I. General information

NPI: 1912912007
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 06/02/2022
Certification Date: 06/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3681 BOILING SPRINGS RD
BOILING SPRINGS SC
29316-6021
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 864-578-2414
  • Fax:
Mailing address:
  • Phone: 217-709-2351
  • Fax: 217-709-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number50007243
License Number StateSC

VII. Legacy identifiers

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

# 1
Identifier4224692
Identifier TypeOTHER
Identifier State
Identifier IssuerOTHER ID NUMBER-COMMERCIAL NUMBER
# 2
Identifier715829
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 3
IdentifierDE2433 DME
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer
# 4
Identifier012564400
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

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