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General NPI Number Information
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NPI Number | 1053715490
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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 | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 8100 MATLOCK RD
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City | ARLINGTON
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State | TX
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Zip | 76002-4102
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Country | US
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Telephone | 817-473-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 1134 HIDDEN RDG APT 2184
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City | IRVING
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State | TX
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Zip | 75038-7989
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY SUPERVISOR
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Name | JERRY PADILLA
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Credential |
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Telephone | 972-822-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 55743
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License Number State | TX
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