=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356623920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALGREENS 4876
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2011
-----------------------------------------------------
Last Update Date | 09/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 NEW DURHAM RD
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08817-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-287-3652
-----------------------------------------------------
Fax | 732-287-3877
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 905 NEW DURHAM RD
-----------------------------------------------------
City | EDISON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08817-2253
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-287-3652
-----------------------------------------------------
Fax | 732-287-3877
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | MR. RICHARD JOHN SZELIGA
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 732-287-3652
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------