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	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1053050450
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	:	217-709-2351
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	833 W 115TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60643-4618
Country	:	US
Telephone Number	:	773-568-4034
Fax Number	:	773-568-4217

Authorized Official
Title or Position	:	MANAGER
Name	:	KIRA L TAYLOR
Credential	:
Telephone Number	:	217-709-2351

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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Directions to “WALGREEN CO. ” Practice Location

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