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General NPI Number Information
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NPI Number | 1942624457
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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 | 02/05/2014
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Last Update Date | 02/05/2014
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Provider Practice Location Address
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Address Line | 2201 S LOOP 256
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City | PALESTINE
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State | TX
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Zip | 75801-4701
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Country | US
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Telephone | 903-723-4705
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Fax |
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Provider Business Mailing Address
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Address Line | 2051 W CUMBERLAND RD APT 1113
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City | TYLER
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State | TX
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Zip | 75703-5343
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Country | US
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Telephone | 508-498-7053
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. AWUNG ASONG
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Credential | PHARMD
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Telephone | 508-498-7053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | TX
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