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	332B00000X	Durable Medical Equipment & Medical Supplies
2	3336C0003X	Community/Retail Pharmacy
3	333600000X	Pharmacy	5301009000	MI

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	2372364	OTHER	MI	NCPDP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720225618
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	:	848 S KALAMAZOO ST
Second Line	:
City	:	PAW PAW
State	:	MI
Zip	:	49079-9230
Country	:	US
Telephone Number	:	269-657-4984
Fax Number	:	269-657-8952

Authorized Official
Title or Position	:	MANAGER
Name	:	KIRA TAYLOR
Credential	:
Telephone Number	:	217-709-2351

Provider Enumeration Date	:	01/14/2009
Last Update Date	:	04/05/2022

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Directions to “WALGREEN CO ” Practice Location

Language	Start Address	Practice Location

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