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General NPI Number Information
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NPI Number | 1265562656
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Entity Type | Organization
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Legal Business Name | WALGREEN CO
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | 1128 S PARK ST
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City | CARROLLTON
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State | GA
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Zip | 30117-4450
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Country | US
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Telephone | 770-836-0770
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Fax | 770-836-7506
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Provider Business Mailing Address
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Address Line | 1901 E VOORHEES ST MS 790
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City | DANVILLE
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State | IL
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Zip | 61834-4509
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Country | US
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Telephone | 217-709-2364
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Fax | 217-709-2344
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Authorized Official
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Title or Position | MANAGER
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Name | VIRGINIA GARZA
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Credential |
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Telephone | 217-709-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | PHRE007615
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0003X
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Taxonomy Name | Managed Care Organization Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PHRE007615
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License Number State | GA
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