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General NPI Number Information
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NPI Number | 1063905552
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Entity Type | Organization
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Legal Business Name | WALGREEN CO
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 200 RUTLEDGE AVE
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City | CHARLESTON
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State | SC
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Zip | 29403-5848
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Country | US
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Telephone | 843-779-3690
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Fax | 843-779-3691
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Provider Business Mailing Address
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Address Line | 1901 E VOORHEES ST MS 790
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City | DANVILLE
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State | IL
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Zip | 61834-4509
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Country | US
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Telephone | 847-527-2489
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Fax | 217-709-2344
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Authorized Official
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Title or Position | MANAGER
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Name | JENNIFER PONCE
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Credential |
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Telephone | 847-527-2489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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