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	3336C0003X	Community/Retail Pharmacy	2443	NE

General Provider Information

NPI Number	:	1396028015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	10725 FORT ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1229
Country	:	US
Telephone Number	:	402-496-2214
Fax Number	:	402-496-2406

Provider Business Practice Location Address
First Line	:	10725 FORT ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68134-1229
Country	:	US
Telephone Number	:	402-496-2214
Fax Number	:	402-496-2406

Authorized Official
Title or Position	:	PHARMACIST
Name	:	MICHAEL O'BRIEN
Credential	:	R.P.
Telephone Number	:	402-496-2214

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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Directions to “WALGREENS ” Practice Location

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