Provider Demographics
NPI:1538488945
Name:WALGREEEN CO.
Entity Type:Organization
Organization Name:WALGREEEN CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MANDEL
Authorized Official - Middle Name:JERMAINE
Authorized Official - Last Name:HEARNS
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:904-778-0871
Mailing Address - Street 1:9700 ARGYLE FOREST BLVD.
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32222-7918
Mailing Address - Country:US
Mailing Address - Phone:904-778-0871
Mailing Address - Fax:
Practice Address - Street 1:9700 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32222-2809
Practice Address - Country:US
Practice Address - Phone:904-778-0871
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS334633336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7979Medicaid