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	333600000X	Pharmacy	01443/01.2	MS
2	3336L0003X	Long Term Care Pharmacy
3	332B00000X	Durable Medical Equipment & Medical Supplies	01443012	MS
4	3336C0003X	Community/Retail Pharmacy

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	870001323	OTHER	MS	MEDICARE FLU

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2511714	OTHER	OTHER ID NUMBER-COMMERCIAL NUMBER

General Provider Information

NPI Number	:	1497838015
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	:	217-709-2386
Fax Number	:	217-709-2344

Provider Business Practice Location Address
First Line	:	738 S GLOSTER ST
Second Line	:
City	:	TUPELO
State	:	MS
Zip	:	38801-4932
Country	:	US
Telephone Number	:	662-844-0432
Fax Number	:	662-844-9853

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/16/2017

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Directions to “WALGREEN CO ” Practice Location

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