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General NPI Number Information
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NPI Number | 1912288028
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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 | 09/01/2011
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Last Update Date | 09/01/2011
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Provider Practice Location Address
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Address Line | 835 W GALENA AVE
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City | FREEPORT
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State | IL
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Zip | 61032-3973
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Country | US
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Telephone | 815-232-8320
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Fax | 815-232-1471
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Provider Business Mailing Address
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Address Line | 913 N MAIN ST APT. 101
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City | ROCKFORD
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State | IL
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Zip | 61103-7068
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Country | US
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Telephone | 773-931-0501
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Fax |
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Authorized Official
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Title or Position | REGISTERED PHARMACIST
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Name | MISS SHU YI YU
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Credential |
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Telephone | 773-931-0501
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 051294491
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License Number State | IL
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