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General NPI Number Information
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NPI Number | 1194093575
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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 | 12/13/2011
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Last Update Date | 12/13/2011
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Provider Practice Location Address
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Address Line | 920 US HIGHWAY 431
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City | BOAZ
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State | AL
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Zip | 35957-1732
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Country | US
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Telephone | 256-593-6090
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Fax | 256-593-7445
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Provider Business Mailing Address
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Address Line | 161 FRIENDSHIP RD
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City | BOAZ
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State | AL
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Zip | 35957-4675
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Country | US
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Telephone | 256-593-0080
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Fax |
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Authorized Official
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Title or Position | CPHT
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Name | MS. SYLVIA CHRISTINE WILKS
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Credential |
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Telephone | 256-593-6092
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 112996
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License Number State | AL
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