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NPI Code Detail

MEDICARE: WALGREEN CO

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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy
3333600000XPharmacy5433MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1623420205OTHERMODME
22628076OTHEROTHER ID NUMBER-COMMERCIAL NUMBER
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548276017
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 : 530 MID RIVERS MALL DR
Second Line :
City : SAINT PETERS
State : MO
Zip : 63376-2150
Country : US
Telephone Number : 636-970-3222
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : KIRA TAYLOR
Credential :
Telephone Number : 217-709-2351
Provider Enumeration Date : 08/01/2006
Last Update Date : 11/09/2023

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1588946404 — MRS. DEIDRA DEANN RODRIGUEZ
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Directions to “WALGREEN CO ” Practice Location

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