Provider Information for 1558376616
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WALGREEN CO
Other Names:Doing Business As:WALGREENS #04105Organization Subpart: YES
NPI: 1558376616
Last Updated: 2023-02-20
Certification Date: 2023-02-20
Certification Date: 2023-02-20
Details
| Name | Value | ||||||||||||||||||||
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| NPI | 1558376616 | ||||||||||||||||||||
| 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 | 12611 S GESSNER RD HOUSTON, TX 77071-2850 United States Phone: 713-266-1853 | Fax:713-779-0910 | ||||||||||||||||||||
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