Healthcare Provider Details

I. General information

NPI: 1679758049
Provider Name (Legal Business Name): WALGREEN CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 SUNRISE VALLEY DR
RESTON VA
20191-3403
US

IV. Provider business mailing address

1901 E VOORHEES ST M/S 790
DANVILLE IL
61834-4509
US

V. Phone/Fax

Practice location:
  • Phone: 703-476-6512
  • Fax:
Mailing address:
  • Phone: 217-709-2386
  • 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 TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number0201004208
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. KERMIT R CRAWFORD
Title or Position: PRESIDENT
Credential:
Phone: 847-315-3154