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General NPI Number Information
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NPI Number | 1558639740
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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 | 12/02/2011
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Last Update Date | 12/02/2011
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Provider Practice Location Address
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Address Line | 40 PIERREPONT AVE APT 2
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City | POTSDAM
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State | NY
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Zip | 13676-2092
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Country | US
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Telephone | 131-532-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 40 PIERREPONT AVE, APT #2
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City | POTSDAM
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State | NY
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Zip | 13676
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Country | US
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Telephone | 131-532-3100
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | MR. JOHN MARRAFFA
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Credential | PHARMD
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Telephone | 13154572531
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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 | 20056453
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License Number State | NY
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