Provider Demographics
NPI:1124039359
Name:WALGREEN CO.
Entity Type:Organization
Organization Name:WALGREEN CO.
Other - Org Name:WALGREENS #10160
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-709-2351
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 790
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:217-709-2351
Mailing Address - Fax:217-709-2344
Practice Address - Street 1:CALLE EBANO ORTEGON Y TABONUCO, LOCAL D-14
Practice Address - Street 2:SAN PATRICIO PLAZA, CAPARRA HEIGHTS
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-0000
Practice Address - Country:US
Practice Address - Phone:787-792-3725
Practice Address - Fax:787-774-0555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREEN BOOTS ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-11
Last Update Date:2023-11-02
Deactivation Date:2007-07-05
Deactivation Code:
Reactivation Date:2008-06-13
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
PR19-F-3454333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4000129OtherNCPDP
0282936375Medicare NSC
PHC049Medicare PIN
P00400633Medicare PIN