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General NPI Number Information
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NPI Number | 1619361912
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Entity Type | Organization
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Legal Business Name | WALGREENS BOOTH ALLIANCE
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/24/2015
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Provider Practice Location Address
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Address Line | 445 E MAPLE AVE
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City | ROSELLE
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State | IL
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Zip | 60172-2203
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Country | US
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Telephone | 630-893-5171
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Fax |
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Provider Business Mailing Address
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Address Line | 445 E MAPLE AVE
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City | ROSELLE
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State | IL
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Zip | 60172-2203
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER/PHARMACIST
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Name | DR. KRYSTYNA KHOPTA
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Credential | PHARMD
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Telephone | 630-893-5171
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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 | 051297137
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License Number State | IL
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