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Provider Information for 1043227051


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WALGREEN CO

Organization Subpart: YES

NPI: 1043227051
Last Updated: 2023-02-22
Certification Date: 2023-02-22

Details

NameValue
NPI1043227051
Enumeration Date2006-08-02
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 7304A LOUETTA RD
SPRING, TX 77379-7234
United States

Phone: 281-379-1317 | Fax:281-379-6275
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)4588957Other ID Number-Commercial Number
MEDICAIDTX463514
MEDICAIDTX470572
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 291U00000X - Clinical Medical Laboratory
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy TX15480