MEDICARE: WALGREEN CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	0201001388	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0201001388	OTHER	VA	BOARD OF PHARMACY
2	4849064	OTHER	VA	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003331950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST # MS 790
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	217-709-2386
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	1671 CRYSTAL SQUARE ARC
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22202-3322
Country	:	US
Telephone Number	:	703-413-0525
Fax Number	:	703-413-4451

Authorized Official
Title or Position	:	MANAGER
Name	:	ALYSSA SWEETEN
Credential	:
Telephone Number	:	217-709-2386

Provider Enumeration Date	:	08/11/2017
Last Update Date	:	05/01/2018

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Directions to “WALGREEN CO ” Practice Location

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