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General NPI Number Information
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NPI Number | 1104107796
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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 | 09/08/2011
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Last Update Date | 09/08/2011
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Provider Practice Location Address
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Address Line | 1201 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2212
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Country | US
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Telephone | 815-962-2812
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 E STATE ST
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City | ROCKFORD
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State | IL
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Zip | 61104-2212
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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 | MR. SEAN FALSEY
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Credential |
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Telephone | 815-397-1587
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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 | 051292971
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License Number State | IL
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