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Provider Information for 1346255478


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #12672

Organization Subpart: YES

NPI: 1346255478
Last Updated: 2022-04-05
Certification Date: 2022-04-05

Details

NameValue
NPI1346255478
Enumeration Date2006-07-29
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 1835 SAND LAKE RD
ORLANDO, FL 32809-7629
United States

Phone: 407-856-1809 | Fax:407-240-4217
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDFL100528600
MEDICAIDFL100528601 DME
Other (non-Medicare)1061554Other ID Number-Commercial Number
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 332B00000X - Durable Medical Equipment & Medical Supplies
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
Yes 333600000X - Pharmacy FLPH0010585