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General NPI Number Information
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NPI Number | 1528341948
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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 | 1155 E SAINT LOUIS ST
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City | SPRINGFIELD
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State | MO
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Zip | 65806-2527
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Country | US
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Telephone | 417-862-5302
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 E SAINT LOUIS ST
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City | SPRINGFIELD
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State | MO
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Zip | 65806-2527
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Country | US
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Telephone | 417-862-5302
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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 | KEVIN WAYNE GASPER
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Credential | RPH
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Telephone | 417-862-5392
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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 | 41094
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License Number State | MO
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