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General NPI Number Information
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NPI Number | 1134498942
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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 | 12/22/2011
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Last Update Date | 12/22/2011
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Provider Practice Location Address
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Address Line | 1001 W STATE ST
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City | TRENTON
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State | OH
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Zip | 45067-1585
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Country | US
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Telephone | 513-737-3504
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Fax |
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Provider Business Mailing Address
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Address Line | 1663 OLD STATE ROUTE 122
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City | LEBANON
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State | OH
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Zip | 45036-9499
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Country | US
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Telephone | 937-478-5506
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. MARK STEPHEN MCCALL
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Credential |
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Telephone | 937-478-5506
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 03315609
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 03315609
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License Number State | OH
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