Provider Demographics
NPI:1215219241
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED IMMUNIZING PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:DENYSE
Authorized Official - Last Name:MENESICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:772-215-2490
Mailing Address - Street 1:2619 NE SABAL PALM WAY
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-6509
Mailing Address - Country:US
Mailing Address - Phone:772-215-2490
Mailing Address - Fax:
Practice Address - Street 1:1661 NW SAINT LUCIE WEST BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2106
Practice Address - Country:US
Practice Address - Phone:772-873-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS476253336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy