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General NPI Number Information
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NPI Number | 1235441494
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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 | 07/04/2010
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Last Update Date | 07/04/2010
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Provider Practice Location Address
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Address Line | 804 N TIBBS RD APT 42
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City | DALTON
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State | GA
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Zip | 30720-2952
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Country | US
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Telephone | 240-723-2375
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Fax |
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Provider Business Mailing Address
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Address Line | 804 N TIBBS RD APT 42
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City | DALTON
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State | GA
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Zip | 30720-2952
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | MRS. NITA R PATEL
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Credential | DPHARM
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Telephone | 706-428-9003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | RPH023013
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License Number State | GA
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