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General NPI Number Information
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NPI Number | 1194094011
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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 | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 524 JEFFERSON AVE
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City | MIAMI BEACH
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State | FL
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Zip | 33139-6303
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Country | US
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Telephone | 305-531-7688
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 VENETIAN WAY APT 2A
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City | MIAMI
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State | FL
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Zip | 33139-1067
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Country | US
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Telephone | 305-322-4710
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. BOB E BECKER
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Credential | RPH
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Telephone | 305-322-4710
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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 | PS19973
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License Number State | FL
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