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Provider Information for 1033124169


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #11085

Organization Subpart: YES

NPI: 1033124169
Last Updated: 2023-11-03
Certification Date: 2023-11-03

Details

NameValue
NPI1033124169
Enumeration Date2006-07-29
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: KIRA L TAYLOR
Title: MANAGER
Phone: 2177092351
Mailing Address 1901 E VOORHEES ST
MS #790
DANVILLE, IL 61834-4509
United States

Phone: 217-709-2351 | Fax:217-709-2344
 
Primary Practice Address 52482 INDIANA STATE ROUTE 933
SOUTH BEND, IN 46637-3852
United States

Phone: 574-271-0357 | Fax:574-243-1516
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDIN100301210
MEDICAIDIN100301210A DME
Other (non-Medicare)1529164Other ID Number-Commercial Number
MEDICAIDMI2861902
MEDICAIDMI4825271 DME
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy IN60004192A