Provider Information for 1093234031
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WALGREEN CO
Other Names:Doing Business As:RITE AID #17320Organization Subpart: YES
NPI: 1093234031
Last Updated: 2017-09-11
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
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| NPI | 1093234031 | ||||||||||||||||
| Enumeration Date | 2017-09-11 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Authorized Official Information | Name: ALAN NIELSEN Title: Ass Treasure Phone: 8473153523 | ||||||||||||||||
| Mailing Address | 1901 E VOORHEES ST # MS 790 DANVILLE, IL 61834-4509 United States Phone: 217-709-2386 | Fax:217-709-2344 | ||||||||||||||||
| Primary Practice Address | 2252 AMBASSADOR CAFFERY PKWY LAFAYETTE, LA 70506-3705 United States Phone: 337-988-7280 | Fax:337-406-2547 | ||||||||||||||||
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