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	261QC1500X	Community Health Clinic/Center	0011421	CT

General Provider Information

NPI Number	:	1467722538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	157 MAIN ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2525
Country	:	US
Telephone Number	:	203-468-9732
Fax Number	:	203-468-9795

Provider Business Practice Location Address
First Line	:	157 MAIN ST
Second Line	:
City	:	EAST HAVEN
State	:	CT
Zip	:	06512-2525
Country	:	US
Telephone Number	:	203-468-9732
Fax Number	:	203-468-9795

Authorized Official
Title or Position	:	CEO
Name	:	GEORGE WASSON
Credential	:
Telephone Number	:	860-657-8014

Provider Enumeration Date	:	01/06/2012
Last Update Date	:	01/06/2012

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Directions to “WALGREENS ” Practice Location

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