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General NPI Number Information
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NPI Number | 1417238452
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Entity Type | Organization
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Legal Business Name | WALGREENS PHARMACY
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Dates
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Enumeration Date | 09/05/2011
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Last Update Date | 09/05/2011
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Provider Practice Location Address
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Address Line | 17071 FORT ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-6656
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Country | US
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Telephone | 734-281-2927
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Fax | 734-281-4979
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Provider Business Mailing Address
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Address Line | 17071 FORT ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-6656
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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 | PHARMACIST
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Name | DR. MARIAM MUFEED HAJEIR
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Credential | PHARM D
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Telephone | 734-281-2927
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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 | 5302039784
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 03230902
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 0000034535
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License Number State | TN
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