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	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	50010065	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4227763	OTHER	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306004478
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	:	1532 LAKE MURRAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8622
Country	:	US
Telephone Number	:	803-732-1975
Fax Number	:	803-732-4746

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	11/02/2023

Similar Medicare Providers

1508873019 — DR. GERALD A FISHMAN MD
Practice Location Address:

1526 LAKE MURRAY BLVD
COLUMBIA, SC
29212-8622

Practice Phone: 803-749-1155
Practice Fax: 803-791-2203

1104969252 — DR. GREGORY K FULCHER MD
Practice Location Address:

1526 LAKE MURRAY BLVD
COLUMBIA, SC
29212-8622

Practice Phone: 803-749-1155
Practice Fax: 803-749-1786

1659589232 — MS. TERESA LYNN HATHCOX FNP-BC
Practice Location Address:

1526 LAKE MURRAY BLVD
COLUMBIA, SC
29212-8622

Practice Phone: 803-749-1155
Practice Fax: 803-749-1786

1881991123 — NATHAN DONOVAN BOYLSTON JR.
Practice Location Address:

1532 LAKE MURRAY BLVD
COLUMBIA, SC
29212-8622

Practice Phone: 803-732-1975
Practice Fax:

1447557491 — MS. EVELIA STEWART PHARMACIST
Practice Location Address:

1532 LAKE MURRAY BLVD
COLUMBIA, SC
29212-8622

Practice Phone: 803-732-1975
Practice Fax: 803-732-4746

1891094926 — RICHARD ALAN GREEN RPH
Practice Location Address:

1532 LAKE MURRAY BLVD
COLUMBIA, SC
29212-8622

Practice Phone: 803-732-1975
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.