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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10604308-1703	OTHER	UT	BOARD OF PHARMACY

General Provider Information

NPI Number	:	1598288532
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	:	2266 E 3300 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84109-2635
Country	:	US
Telephone Number	:	801-485-4852
Fax Number	:	801-485-6790

Authorized Official
Title or Position	:	MANAGER
Name	:	ALYSSA SWEETEN
Credential	:
Telephone Number	:	217-709-2386

Provider Enumeration Date	:	07/21/2017
Last Update Date	:	06/15/2018

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Directions to “WALGREEN CO ” Practice Location

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