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General NPI Number Information
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NPI Number | 1154604841
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Entity Type | Organization
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Legal Business Name | WALLGREENS
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 1414 EL CAMINO REAL
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City | SAN CARLOS
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State | CA
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Zip | 94070-0000
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Country | US
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Telephone | 650-637-9777
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Fax | 650-637-1012
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Provider Business Mailing Address
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Address Line | 1414 EL CAMINO REAL
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City | SAN CARLOS
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State | CA
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Zip | 94070
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Country | US
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Telephone | 650-637-9777
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Fax | 650-637-1012
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Authorized Official
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Title or Position | PHARMACIST
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Name | CONJA SO-ROSILLO
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Credential | PHARMD
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Telephone | 650-637-9777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | RPH52616
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License Number State | CA
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