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General NPI Number Information
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NPI Number | 1598016826
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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 | 09/26/2012
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 13500 HIGHWAY 90
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City | BOUTTE
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State | LA
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Zip | 70039-3500
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Country | US
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Telephone | 985-331-1866
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Fax | 985-331-8256
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Provider Business Mailing Address
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Address Line | 13500 HIGHWAY 90
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City | BOUTTE
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State | LA
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Zip | 70039-3500
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Country | US
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Telephone | 985-331-1866
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Fax | 985-331-8256
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. LARRY W HASTEN
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Credential | PHARMACIST
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Telephone | 985-331-1866
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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 | 10471
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License Number State | LA
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