Provider Demographics
NPI:1457634057
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JITENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DHRUVA
Authorized Official - Suffix:
Authorized Official - Credentials:BPHARM
Authorized Official - Phone:847-673-8063
Mailing Address - Street 1:9150 SKOKIE BLVD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1785
Mailing Address - Country:US
Mailing Address - Phone:847-673-8063
Mailing Address - Fax:847-673-8267
Practice Address - Street 1:9150 SKOKIE BLVD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1785
Practice Address - Country:US
Practice Address - Phone:847-673-8063
Practice Address - Fax:847-673-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0510325423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy