Provider Information for 1003593609
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WALGREEN CO.
Other Names:Doing Business As:WALGREENS #21561Organization Subpart: YES
NPI: 1003593609
Last Updated: 2023-09-08
Certification Date: 2023-09-08
Certification Date: 2023-09-08
Details
| Name | Value | ||||||||||||||||
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| NPI | 1003593609 | ||||||||||||||||
| Enumeration Date | 2023-07-05 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: KIRA L TAYLOR Title: manager Phone: 2177092351 | ||||||||||||||||
| Mailing Address | 1901 E VOORHEES ST MS/790 DANVILLE, IL 61834 United States Phone: 217-709-2494 | Fax: | ||||||||||||||||
| Primary Practice Address | 1500 BONIN ROAD YOUNGSVILLE, LA 70592 United States Phone: 337-573-6176 | Fax: | ||||||||||||||||
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