Provider Demographics
NPI:1598036287
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANUALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MBARUSHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-340-1107
Mailing Address - Street 1:1432 ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:TX
Mailing Address - Zip Code:79821-7146
Mailing Address - Country:US
Mailing Address - Phone:915-886-2413
Mailing Address - Fax:
Practice Address - Street 1:1432 ANTONIO ST
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:TX
Practice Address - Zip Code:79821-7146
Practice Address - Country:US
Practice Address - Phone:915-886-2413
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX490643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy