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General NPI Number Information
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NPI Number | 1851695936
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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 | 01/04/2011
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 104 WILMOT RD MSC 1435
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City | DEERFIELD
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State | IL
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Zip | 60015-5121
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Country | US
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Telephone | 217-709-2386
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Fax |
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Provider Business Mailing Address
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Address Line | 104 WILMOT RD MSC 1435
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City | DEERFIELD
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State | IL
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Zip | 60015-5121
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Country | US
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Telephone | 217-709-2386
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JOHN A MANN
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Credential |
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Telephone | 847-527-4640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336M0002X
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Taxonomy Name | Mail Order Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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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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