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Provider Information for 1568679439


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #10319

Organization Subpart: YES

NPI: 1568679439
Last Updated: 2023-11-08
Certification Date: 2023-11-08

Details

NameValue
NPI1568679439
Enumeration Date2007-05-17
NPI TypeNPI-2 Organization
StatusActive
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 472 LINCOLN ST.
WORCESTER, MA 01605-1917
United States

Phone: 508-856-7923 | Fax:508-856-7929
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMA110072943J
Other (non-Medicare)2241773NCPDP
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
No 3336C0003X - Pharmacy - Community/Retail Pharmacy
No 332B00000X - Durable Medical Equipment & Medical Supplies
Yes 333600000X - Pharmacy MA3517