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Provider Information for 1386659639


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #01826

Organization Subpart: YES

NPI: 1386659639
Last Updated: 2023-10-30
Certification Date: 2023-10-30

Details

NameValue
NPI1386659639
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 324 N MAIN ST
WEST HARTFORD, CT 06117-2675
United States

Phone: 860-236-1980 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDCT004230728 DME
Other (non-Medicare)0711879Other ID Number-Commercial Number
MEDICAIDCT940004068201
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy CT1135