Provider Demographics
NPI:1376152132
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RXM
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAROY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-240-2954
Mailing Address - Street 1:484 S TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48161-1612
Mailing Address - Country:US
Mailing Address - Phone:734-240-2954
Mailing Address - Fax:
Practice Address - Street 1:484 S TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48161-1612
Practice Address - Country:US
Practice Address - Phone:734-240-2954
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty