Provider Demographics
NPI:1003196726
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIS
Authorized Official - Prefix:MR
Authorized Official - First Name:PARVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MISCHEL JR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-987-7494
Mailing Address - Street 1:1081 GA HIGHWAY 96
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2507
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1081 GA HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-2507
Practice Address - Country:US
Practice Address - Phone:478-987-7494
Practice Address - Fax:478-957-7517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022528333600000X
KY006812333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy