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Provider Information for 1063427045


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #09693

Organization Subpart: YES

NPI: 1063427045
Last Updated: 2023-11-03
Certification Date: 2023-11-03

Details

NameValue
NPI1063427045
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 1000 E CARL ALBERT PKWY
MCALESTER, OK 74501-5121
United States

Phone: 918-426-7657 | Fax:918-429-0794
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDOK100245370G
MEDICAIDOK100245370H DME
Other (non-Medicare)3724324Other 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 OK15-5034