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General NPI Number Information
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NPI Number | 1699058149
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Entity Type | Organization
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Legal Business Name | WALGREENS DRUG STORE
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Dates
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Enumeration Date | 09/21/2011
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Last Update Date | 09/21/2011
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Provider Practice Location Address
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Address Line | 5460 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6449
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Country | US
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Telephone | 317-351-5973
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Fax | 317-351-8781
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Provider Business Mailing Address
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Address Line | 5460 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6449
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Country | US
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Telephone | 317-351-5973
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Fax | 317-351-8781
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | LISA LOUKS
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Credential | RPH
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Telephone | 317-351-5973
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26015312
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License Number State | IN
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