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General NPI Number Information
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NPI Number | 1306386073
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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 | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 10787 CAMINO RUIZ
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City | SAN DIEGO
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State | CA
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Zip | 92126-2304
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Country | US
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Telephone | 858-437-0762
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Fax |
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Provider Business Mailing Address
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Address Line | 4152 32ND ST APT 11
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City | SAN DIEGO
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State | CA
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Zip | 92104-2032
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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 | DISTRICT MANAGER
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Name | SOPHIE GENICOT
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Credential |
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Telephone | 858-647-4847
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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 | 52947
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License Number State | CA
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