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General NPI Number Information
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NPI Number | 1144598194
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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 | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 10620 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-2310
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Country | US
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Telephone | 773-238-2289
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Fax |
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Provider Business Mailing Address
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Address Line | 10620 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-2310
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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 | PHAMACY MANAGER
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Name | EVERETTE REDWELL
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Credential |
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Telephone | 773-238-2289
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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 | 051.293635
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License Number State | IL
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