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General NPI Number Information
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NPI Number | 1033513171
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Entity Type | Organization
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Legal Business Name | WALGREENS
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Dates
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Enumeration Date | 10/17/2014
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 2395 JOHN KENNEDY BLVD
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City | JERSEY CITY
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State | NJ
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Zip | 07304
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Country | US
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Telephone | 201-333-4092
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Fax |
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Provider Business Mailing Address
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Address Line | 2395 JOHN KENNEDY BLVD
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City | JERSEY CITY
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State | NJ
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Zip | 07304
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Country | US
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Telephone | 201-333-4092
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | DR. JOHN COLLAZZI
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Credential | PHARM D.
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Telephone | 201-333-4092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 28RI03666400
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License Number State | NJ
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