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General NPI Number Information
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NPI Number | 1316222094
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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 | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 2355 NE 26TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33305
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Country | US
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Telephone | 954-561-3880
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Fax |
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Provider Business Mailing Address
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Address Line | 2355 NE 26TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33305
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Country | US
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Telephone | 954-561-3880
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Fax |
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Authorized Official
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Title or Position | PHARMACISTS
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Name | DR. JAMES FINTAK
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Credential | RPH
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Telephone | 954-561-3880
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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 | PS45567
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License Number State | FL
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