MEDICARE: WALGREENS

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	333600000X	Pharmacy	18121-40	WI

General Provider Information

NPI Number	:	1972989861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALGREENS

Provider Business Mailing Address
First Line	:	3528 S CLEMENT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-3502
Country	:	US
Telephone Number	:	262-412-4069
Fax Number	:

Provider Business Practice Location Address
First Line	:	3528 S CLEMENT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-3502
Country	:	US
Telephone Number	:	262-412-4069
Fax Number	:

Authorized Official
Title or Position	:	PHARM D.
Name	:	JASON SLAASTED
Credential	:
Telephone Number	:	262-412-4069

Provider Enumeration Date	:	08/03/2015
Last Update Date	:	08/03/2015

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Directions to “WALGREENS ” Practice Location

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