=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801203815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALGREEN CO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2014
-----------------------------------------------------
Last Update Date | 07/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10121 SEMINOLE BLVD
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33772-2543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-7308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10121 SEMINOLE BLVD
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33772-2543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-7308
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST
-----------------------------------------------------
Name | HEATHER LEE GOOD
-----------------------------------------------------
Credential | PHARMD
-----------------------------------------------------
Telephone | 941-773-3281
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PS52082
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------