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General NPI Number Information
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NPI Number | 1699057596
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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 | 09/15/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 124 E NORTH ST
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City | KENDALLVILLE
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State | IN
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Zip | 46755-1124
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Country | US
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Telephone | 260-349-1530
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Fax | 260-349-1936
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Provider Business Mailing Address
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Address Line | 11728 CORAL SPRINGS DR
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City | FORT WAYNE
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State | IN
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Zip | 46845-9594
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Country | US
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Telephone | 260-338-1016
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | MICHAEL S JONES
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Credential | PHARM.D.
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Telephone | 260-338-1016
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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 | 26021102A
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License Number State | IN
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