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	PHY.007610-RC	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1940748	OTHER	LA	NCPDP

General Provider Information

NPI Number	:	1073039327
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	:	3401 SAINT CHARLES AVE
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70115-4535
Country	:	US
Telephone Number	:	504-896-4575
Fax Number	:	504-896-4598

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

Provider Enumeration Date	:	08/18/2017
Last Update Date	:	06/15/2018

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Directions to “WALGREEN CO. ” Practice Location

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