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General NPI Number Information
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NPI Number | 1043595366
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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 | 10/18/2011
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Last Update Date | 10/18/2011
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Provider Practice Location Address
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Address Line | 3312 E 29TH ST
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City | BRYAN
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State | TX
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Zip | 77802-2730
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Country | US
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Telephone | 979-776-9128
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Fax |
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Provider Business Mailing Address
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Address Line | 3312 E 29TH ST
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City | BRYAN
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State | TX
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Zip | 77802-2730
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Country | US
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Telephone | 979-776-9128
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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 | CHAD STONECIPER
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Credential |
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Telephone | 512-459-2295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 50104
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License Number State | TX
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