MEDICARE: WALGREEN CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy

General Provider Information

NPI Number	:	1407379282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST # MS 790
Second Line	:
City	:	DANVILLE
State	:	IL
Zip	:	61834-4509
Country	:	US
Telephone Number	:	217-709-2386
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	1540 GRAND CONCOURSE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8400
Country	:	US
Telephone Number	:	718-731-8733
Fax Number	:	718-731-5664

Authorized Official
Title or Position	:	ASST TREASURER
Name	:	ALAN NIELSEN
Credential	:
Telephone Number	:	847-315-3523

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	09/22/2017

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Directions to “WALGREEN CO ” Practice Location

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