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General NPI Number Information
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NPI Number | 1083063945
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Entity Type | Organization
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Legal Business Name | HEALTH CARE CLINIC AT WALGREENS
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 1724 NW 126TH DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 404-671-6773
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Fax |
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Provider Business Mailing Address
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Address Line | 1724 NW 126TH DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33071
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Country | US
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Telephone | 404-671-6773
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MS. BETSY MARTINEZ
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Credential |
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Telephone | 847-315-7980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 1956765
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License Number State | FL
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