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General NPI Number Information
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NPI Number | 1770998163
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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 | 06/25/2014
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Last Update Date | 06/25/2014
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Provider Practice Location Address
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Address Line | 1380 LEXINGTON AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-2616
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Country | US
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Telephone | 419-756-2609
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Fax | 419-756-8140
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Provider Business Mailing Address
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Address Line | 1380 LEXINGTON AVE
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City | MANSFIELD
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State | OH
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Zip | 44907-2616
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Country | US
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Telephone | 419-756-2609
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Fax | 419-756-8140
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | GRACE M KILBANE
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Credential | PHARM D
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Telephone | 614-638-5018
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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 | 03233743
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License Number State | OH
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