=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013256601
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALGREENS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2013
-----------------------------------------------------
Last Update Date | 02/03/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1413 S KENMORE ST
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-5126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-595-5304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1413 S KENMORE ST
-----------------------------------------------------
City | ANAHEIM
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92804-5126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-595-5304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. BAO THAT TON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-595-5304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 281P00000X
-----------------------------------------------------
Taxonomy Name | Chronic Disease Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------