Provider Demographics
NPI:1598066243
Name:WALGREEN SPECIALTY PHARMACY, LLC
Entity Type:Organization
Organization Name:WALGREEN SPECIALTY PHARMACY, LLC
Other - Org Name:ALLIANCERX WALGREENS PHARMACY #15443
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-709-2351
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 792
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:217-709-2386
Mailing Address - Fax:217-709-2344
Practice Address - Street 1:10530 JOHN ELLIOTT DRIVE
Practice Address - Street 2:STE. 100
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75033-0000
Practice Address - Country:US
Practice Address - Phone:214-387-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREENS BOOTS ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-11-11
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5903023OtherNCPDP