Provider Demographics
NPI:1407130370
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FRANTZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-748-1086
Mailing Address - Street 1:7461 NW 37TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4932
Mailing Address - Country:US
Mailing Address - Phone:954-767-4507
Mailing Address - Fax:954-767-9548
Practice Address - Street 1:1 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311
Practice Address - Country:US
Practice Address - Phone:954-767-4507
Practice Address - Fax:954-767-9548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31114183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10129600OtherPHARMACIST