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	09897	NC

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	3408766	OTHER		NCPDP

General Provider Information

NPI Number	:	1134326978
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	:	217-709-2364
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	12311 N NC HWY 150
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27127-9730
Country	:	US
Telephone Number	:	336-764-2581
Fax Number	:	336-764-9841

Authorized Official
Title or Position	:	MANAGER
Name	:	VIRGINIA GARZA
Credential	:
Telephone Number	:	217-709-2364

Provider Enumeration Date	:	06/27/2007
Last Update Date	:	07/26/2024

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12208 N NC HIGHWAY 150
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1427006451 — FORSYTH MEMORIAL HOSPITAL INC
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1457450694 — ECKERD CORPORATION
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Practice Fax:

1932385861 — MRS. VANESSA MARIA PRATT
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1306088380 — MRS. STACY MENDENHALL HILL NP-C
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1205156627 — MRS. ALLISON MICHELLE BREWER NP
Practice Location Address:

12208 N NC HIGHWAY 150
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Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

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