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NPI Code Detail

MEDICARE: WALGREENS PHARMACY

MEDICARE: WALGREENS PHARMACY
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
1302R00000XHealth Maintenance OrganizationTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578891016
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALGREENS PHARMACY
Provider Business Mailing Address
First Line : 4415 N STATELINE AVE
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-3138
Country : US
Telephone Number : 903-795-8918
Fax Number : 903-792-6198
Provider Business Practice Location Address
First Line : 4415 N STATELINE AVE
Second Line :
City : TEXARKANA
State : TX
Zip : 75503-3138
Country : US
Telephone Number : 903-795-8918
Fax Number : 903-792-6198
Authorized Official
Title or Position : PHARMACIST
Name : MR. JOE N FANT
Credential : BS
Telephone Number : 903-792-8918
Provider Enumeration Date : 11/20/2009
Last Update Date : 11/20/2009

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1760718308 — DR. CHRISTOPHER JOSEPH EATON PHARM.D.
Practice Location Address:
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75503-3138
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Practice Location Address:
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Practice Location Address:
4415 N STATE LINE AVE
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Directions to “WALGREENS PHARMACY ” Practice Location

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