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General NPI Number Information
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NPI Number | 1396012290
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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 | 11/19/2011
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Last Update Date | 11/19/2011
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Provider Practice Location Address
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Address Line | 6800 W 28TH AVE
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City | HIALEAH
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State | FL
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Zip | 33018-5305
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Country | US
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Telephone | 305-828-0268
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Fax |
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Provider Business Mailing Address
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Address Line | 5069 SW 139TH AVE
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City | MIRAMAR
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State | FL
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Zip | 33027-5947
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Country | US
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Telephone | 305-788-5865
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Fax |
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Authorized Official
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Title or Position | RPH
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Name | DR. DELANO WAYNE STEPHENSON
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Credential | PHARMD
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Telephone | 305-788-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 46535
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License Number State | FL
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