Provider Demographics
NPI:1134498942
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:WALGREENS
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MCCALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-478-5506
Mailing Address - Street 1:1663 OLD STATE ROUTE 122
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-9499
Mailing Address - Country:US
Mailing Address - Phone:937-478-5506
Mailing Address - Fax:
Practice Address - Street 1:1001 W STATE ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:OH
Practice Address - Zip Code:45067-1585
Practice Address - Country:US
Practice Address - Phone:513-737-3504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03315609261QC1500X, 305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No305S00000XManaged Care OrganizationsPoint of Service