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General NPI Number Information
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NPI Number | 1558729491
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Entity Type | Organization
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Legal Business Name | WALGREEN EASTERN CO INC
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Dates
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Enumeration Date | 02/07/2016
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Last Update Date | 08/16/2018
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Provider Practice Location Address
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Address Line | 49 KELLOGG RD
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City | NEW HARTFORD
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State | NY
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Zip | 13413
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Country | US
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Telephone | 315-734-1893
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Fax | 315-734-1896
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Provider Business Mailing Address
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Address Line | 49 KELLOGG RD
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City | NEW HARTFORD
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State | NY
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Zip | 13413-2849
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Country | US
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Telephone | 315-734-1893
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Fax | 315-734-1896
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. DAVID NICHOLAS GOODMAN
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Credential | DR
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Telephone | 315-404-4859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | I060633-1
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License Number State | NY
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