Provider Information for 1790790061
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WALGREEN CO
Other Names:Doing Business As:WALGREENS #02364Organization Subpart: YES
NPI: 1790790061
Last Updated: 2023-10-25
Certification Date: 2023-10-25
Certification Date: 2023-10-25
Details
| Name | Value | ||||||||||||||||
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| NPI | 1790790061 | ||||||||||||||||
| Enumeration Date | 2006-07-29 | ||||||||||||||||
| NPI Type | NPI-2 Organization | ||||||||||||||||
| Status | Active | ||||||||||||||||
| 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 | 819 W MAIN ST JACKSONVILLE, AR 72076-4435 United States Phone: 501-241-0225 | Fax:501-241-0228 | ||||||||||||||||
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