Provider Demographics
NPI:1235322405
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALTAF
Authorized Official - Middle Name:KAUSAR
Authorized Official - Last Name:FAROOQI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:505-982-9811
Mailing Address - Street 1:1096 S SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1654
Mailing Address - Country:US
Mailing Address - Phone:505-982-9811
Mailing Address - Fax:505-982-1072
Practice Address - Street 1:6605 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6112
Practice Address - Country:US
Practice Address - Phone:505-982-9811
Practice Address - Fax:505-982-1072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service