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General NPI Number Information
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NPI Number | 1215210935
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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 | 09/20/2011
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 2220 HEWATT RD
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City | SNELLVILLE
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State | GA
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Zip | 30039-4021
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Country | US
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Telephone | 770-978-6276
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Fax | 770-978-6563
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Provider Business Mailing Address
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Address Line | 2220 HEWATT RD
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City | SNELLVILLE
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State | GA
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Zip | 30039-4021
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Country | US
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Telephone | 770-978-6276
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Fax | 770-978-6563
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | SEBLE MAKONNEN
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Credential | PHARM. D
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Telephone | 770-978-6276
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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 | RPH021457
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License Number State | GA
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