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Provider Information for 1407861446


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #09444

Organization Subpart: YES

NPI: 1407861446
Last Updated: 2024-10-09
Certification Date: 2024-10-09

Details

NameValue
NPI1407861446
Enumeration Date2006-07-29
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: JENNIFER PONCE
Title: MANAGER
Phone: 8475272489
Mailing Address 1901 E VOORHEES ST
MS #790
DANVILLE, IL 61834-4509
United States

Phone: 847-527-2489 | Fax:217-709-2344
 
Primary Practice Address 312 E GAINES ST
LAWRENCEBURG, TN 38464-3532
United States

Phone: 931-762-6840 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Other (non-Medicare)4438619Other ID Number-Commercial Number
MEDICAIDTN4438619
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 333600000X - Pharmacy TN4236
No 3336C0003X - Pharmacy - Community/Retail Pharmacy