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General NPI Number Information
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NPI Number | 1477834406
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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 | 09/04/2011
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Last Update Date | 09/04/2011
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Provider Practice Location Address
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Address Line | 4210 E STATE ROAD 64
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City | BRADENTON
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State | FL
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Zip | 34208-9095
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Country | US
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Telephone | 941-708-9161
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Fax | 941-708-9482
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Provider Business Mailing Address
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Address Line | 4210 E STATE ROAD 64
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City | BRADENTON
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State | FL
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Zip | 34208-9095
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Country | US
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Telephone | 941-708-9161
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Fax | 941-708-9482
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Authorized Official
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Title or Position | PHARMACIST
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Name | GIAU THUY LE
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Credential | PHARMD
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Telephone | 813-716-6911
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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 | PS38183
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License Number State | FL
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