=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134503261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALGREENS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2015
-----------------------------------------------------
Last Update Date | 07/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 RIVERLAND DR
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-773-2909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 RIVERLAND DR
-----------------------------------------------------
City | CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29412-2345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-773-2909
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | JACLYN TAYLOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 440-773-2909
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 03233550
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number | 36009
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------