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Provider Information for 1073038352


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #17685

Organization Subpart: YES

NPI: 1073038352
Last Updated: 2022-05-16
Certification Date: 2022-05-16

Details

NameValue
NPI1073038352
Enumeration Date2017-08-08
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: KIRA 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 14 MCGRATH HWY STE 3
SOMERVILLE, MA 02143-4509
United States

Phone: 617-776-3000 | Fax:617-776-1491
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMA0403156
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy MADS90192