=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417227653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALGREENS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/05/2012
-----------------------------------------------------
Last Update Date | 01/05/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1350 N WICKHAM RD
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32935-8945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-254-5507
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1350 N WICKHAM RD
-----------------------------------------------------
City | MELBOURNE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32935-8945
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | JOHN P ABRAMO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 321-254-5507
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 26630
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------