Provider Demographics
NPI:1366816845
Name:WALGREEN'S
Entity Type:Organization
Organization Name:WALGREEN'S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KONKOL
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:510-427-1673
Mailing Address - Street 1:4051 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2069
Mailing Address - Country:US
Mailing Address - Phone:505-892-6690
Mailing Address - Fax:
Practice Address - Street 1:4051 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2069
Practice Address - Country:US
Practice Address - Phone:505-892-6690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-19
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP000084693336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy