Provider Demographics
NPI: | 1356866172 |
---|---|
Name: | WALGREEN CO |
Entity Type: | Organization |
Organization Name: | WALGREEN CO |
Other - Org Name: | RITE AID #20577 |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | ASST TREASURER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ALAN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | NIELSEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 847-315-3523 |
Mailing Address - Street 1: | 1901 E VOORHEES ST # MS 790 |
Mailing Address - Street 2: | |
Mailing Address - City: | DANVILLE |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 61834-4509 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 217-709-2386 |
Mailing Address - Fax: | 217-709-2344 |
Practice Address - Street 1: | 353 US HIGHWAY 202/206 |
Practice Address - Street 2: | |
Practice Address - City: | BRIDGEWATER |
Practice Address - State: | NJ |
Practice Address - Zip Code: | 08807-2442 |
Practice Address - Country: | US |
Practice Address - Phone: | 908-722-8123 |
Practice Address - Fax: | 908-722-6859 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | WALGREENS BOOTS ALLIANCE INC |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2017-08-14 |
Last Update Date: | 2017-08-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 333600000X | Suppliers | Pharmacy | |
No | 3336C0003X | Suppliers | Pharmacy | Community/Retail Pharmacy |