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General NPI Number Information
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NPI Number | 1083169841
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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 | 08/22/2016
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Last Update Date | 08/22/2016
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Provider Practice Location Address
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Address Line | 5036 S COTTAGE GROVE AVE
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City | CHICAGO
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State | IL
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Zip | 60615-2642
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Country | US
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Telephone | 773-373-6266
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Fax |
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Provider Business Mailing Address
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Address Line | 8120 S COLFAX AVE
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City | CHICAGO
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State | IL
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Zip | 60617-1201
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Country | US
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Telephone | 773-470-9831
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | CARLINE JOSEPH
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Credential |
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Telephone | 773-470-9831
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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 | 051299772
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License Number State | IL
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