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	3336C0003X	Community/Retail Pharmacy
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	333600000X	Pharmacy	0201004208	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4840701	OTHER		NCPDP

General Provider Information

NPI Number	:	1679758049
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREEN CO

Provider Business Mailing Address
First Line	:	1901 E VOORHEES ST
Second Line	:	M/S 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	:	12000 SUNRISE VALLEY DR
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20191-3403
Country	:	US
Telephone Number	:	703-476-6512
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KERMIT R CRAWFORD
Credential	:
Telephone Number	:	847-315-3154

Provider Enumeration Date	:	01/04/2008
Last Update Date	:	12/15/2011

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Directions to “WALGREEN CO ” Practice Location

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