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General NPI Number Information
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NPI Number | 1538488945
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Entity Type | Organization
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Legal Business Name | WALGREEEN CO.
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Dates
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Enumeration Date | 05/25/2010
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Last Update Date | 05/25/2010
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Provider Practice Location Address
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Address Line | 9700 ARGYLE FOREST BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32222-2809
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Country | US
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Telephone | 904-778-0871
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Fax |
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Provider Business Mailing Address
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Address Line | 9700 ARGYLE FOREST BLVD.
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City | JACKSONVILLE
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State | FL
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Zip | 32222-7918
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Country | US
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Telephone | 904-778-0871
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. MANDEL JERMAINE HEARNS
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Credential | PHARM. D
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Telephone | 904-778-0871
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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 | PS33463
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License Number State | FL
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