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General NPI Number Information
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NPI Number | 1497038814
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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 | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 350 BRODERICK ST APT 310
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-2278
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Country | US
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Telephone | 415-305-3704
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Fax |
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Provider Business Mailing Address
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Address Line | 350 BRODERICK ST APT 310
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City | SAN FRANCISCO
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State | CA
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Zip | 94117-2278
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Country | US
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Telephone | 415-305-3704
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | MISS CHRISTINA SONG
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Credential | PHARM D
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Telephone | 415-305-3704
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 55155
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License Number State | CA
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