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General NPI Number Information
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NPI Number | 1124423744
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Entity Type | Organization
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Legal Business Name | WALGREENS CO.
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Dates
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Enumeration Date | 10/24/2014
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Last Update Date | 10/24/2014
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Provider Practice Location Address
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Address Line | 611 MALL RING CIR
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City | HENDERSON
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State | NV
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Zip | 89014-6619
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Country | US
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Telephone | 702-433-0144
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Fax |
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Provider Business Mailing Address
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Address Line | 611 MALL RING CIR
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City | HENDERSON
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State | NV
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Zip | 89014-6619
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Country | US
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Telephone | 702-433-0144
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | KSENIYA KOZLOVA
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Credential | PHARMD
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Telephone | 702-547-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 18823
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License Number State | NV
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