MEDICARE: WALGREENS

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	183500000X	Pharmacist

General Provider Information

NPI Number	:	1114273307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	6401 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6401 W CHARLESTON BLVD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89146-1118
Country	:	US
Telephone Number	:	702-259-7002
Fax Number	:

Authorized Official
Title or Position	:	PHARMACIST
Name	:	CORRINE TRAVOUS
Credential	:
Telephone Number	:	702-428-7009

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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Directions to “WALGREENS ” Practice Location

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