Provider Demographics
NPI:1629477419
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRIGID
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-863-6416
Mailing Address - Street 1:5611 N 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-4239
Mailing Address - Country:US
Mailing Address - Phone:618-978-3323
Mailing Address - Fax:
Practice Address - Street 1:1930 W GRAND ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-4870
Practice Address - Country:US
Practice Address - Phone:417-863-6416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health