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General NPI Number Information
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NPI Number | 1215219241
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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 | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 1661 NW SAINT LUCIE WEST BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-2106
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Country | US
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Telephone | 772-873-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 2619 NE SABAL PALM WAY
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City | JENSEN BEACH
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State | FL
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Zip | 34957-6509
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Country | US
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Telephone | 772-215-2490
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Fax |
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Authorized Official
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Title or Position | REGISTERED IMMUNIZING PHARMACIST
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Name | MS. KARA DENYSE MENESICK
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Credential | PHARM D.
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Telephone | 772-215-2490
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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 | PS47625
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License Number State | FL
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