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	50013544	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4230316	OTHER	SC	NCPDP

General Provider Information

NPI Number	:	1104114388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	MS 790
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	:	3501 HIGHWAY 153
Second Line	:
City	:	GREENVILLE
State	:	SC
Zip	:	29611-7515
Country	:	US
Telephone Number	:	864-295-2029
Fax Number	:	864-295-8904

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

Provider Enumeration Date	:	07/21/2011
Last Update Date	:	04/08/2022

Similar Medicare Providers

1265413587 — DR. VALERIE S URBAN OPTOMETRIST
Practice Location Address:

3529 HIGHWAY 153
GREENVILLE, SC
29611-7515

Practice Phone: 864-295-3550
Practice Fax: 864-295-3242

1033190350 — ANDERSON OPTOMETRIC ASSOCIATES
Practice Location Address:

3529 HIGHWAY 153
GREENVILLE, SC
29611-7515

Practice Phone: 864-295-3550
Practice Fax: 864-295-3242

1003113267 — DR. KARLA LEIGH CARUSO PHARM D
Practice Location Address:

3501 HIGHWAY 153
GREENVILLE, SC
29611-7515

Practice Phone: 864-295-2029
Practice Fax:

1861089955 — MALLORIE STANZIONE
Practice Location Address:

3501 HIGHWAY 153
GREENVILLE, SC
29611-7515

Practice Phone: 864-295-2029
Practice Fax:

1265029367 — DR. CRAIG AUSTIN EVANS PHARMD
Practice Location Address:

3501 HIGHWAY 153
GREENVILLE, SC
29611-7515

Practice Phone: 864-295-2029
Practice Fax:

1801526165 — MACY SPARKS OD
Practice Location Address:

3529 HIGHWAY 153
GREENVILLE, SC
29611-7515

Practice Phone: 864-654-6706
Practice Fax:

Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.