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General NPI Number Information
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NPI Number | 1629338413
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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 | 05/25/2012
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 2525 W ANDERSON LN
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City | AUSTIN
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State | TX
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Zip | 78757-1180
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Country | US
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Telephone | 512-323-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 15225 DONNA JANE LOOP
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City | PFLUGERVILLE
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State | TX
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Zip | 78660-4950
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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 | PHARMACIST
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Name | DR. MELISSA SUNHWI KIM
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Credential | PHARM.D.
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Telephone | 213-400-6623
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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 | 51046
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License Number State | TX
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