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Provider Information for 1992710172


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WALGREEN CO

Other Names:  
Doing Business As: 
WALGREENS #06487

Organization Subpart: YES

NPI: 1992710172
Last Updated: 2022-05-09
Certification Date: 2022-05-09

Details

NameValue
NPI1992710172
Enumeration Date2006-07-29
NPI TypeNPI-2 Organization
StatusActive
Authorized Official Information Name: KIRA L TAYLOR
Title: Manager
Phone: 2177092351
Mailing Address 1901 E VOORHEES ST
MAILSTOP #790
DANVILLE, IL 61834-4509
United States

Phone: 217-709-2351 | Fax:217-709-2344
 
Primary Practice Address 3495 BAYSIDE LAKES BLVD SE
PALM BAY, FL 32909-6814
United States

Phone: 321-409-2828 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDFL025144500
MEDICAIDFL025144501 DME
Other (non-Medicare)1093311Other 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 FLPH018243