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General NPI Number Information
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NPI Number | 1679526974
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Entity Type | Organization
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Legal Business Name | WALGREENS SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 12/31/2015
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Provider Practice Location Address
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Address Line | 412 MOUNT KEMBLE AVE SUITE 300N
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City | MORRISTOWN
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State | NJ
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Zip | 07960-6666
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Country | US
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Telephone | 800-876-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1901 E VOORHEES ST MS 790
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City | DANVILLE
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State | IL
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Zip | 61834-4509
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Country | US
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Telephone | 217-709-2386
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Fax | 217-709-2344
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Authorized Official
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Title or Position | TREASURER
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Name | MR. ALAN T NIELSEN
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Credential |
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Telephone | 847-315-3523
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 28RS00656500
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License Number State | NJ
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