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General NPI Number Information
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NPI Number | 1164771820
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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 | 09/10/2012
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Last Update Date | 09/10/2012
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Provider Practice Location Address
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Address Line | 4111 N 24TH ST
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City | PHOENIX
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State | AZ
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Zip | 85016-6222
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Country | US
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Telephone | 602-381-0696
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Fax | 602-381-0696
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Provider Business Mailing Address
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Address Line | 5324 E WASHINGTON ST
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City | PHOENIX
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State | AZ
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Zip | 85034-2144
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Country | US
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Telephone | 602-732-3384
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Fax | 602-732-3394
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Authorized Official
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Title or Position | PHARMACY SUPERVISOR
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Name | NICOLE LEITER
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Credential |
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Telephone | 602-577-6476
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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 | S019460
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License Number State | AZ
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