Provider Demographics
NPI:1639582604
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLYE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLTGRAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:314-739-4503
Mailing Address - Street 1:600 THIEBES RD
Mailing Address - Street 2:
Mailing Address - City:LABADIE
Mailing Address - State:MO
Mailing Address - Zip Code:63055-1710
Mailing Address - Country:US
Mailing Address - Phone:636-751-5778
Mailing Address - Fax:
Practice Address - Street 1:4218 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-2916
Practice Address - Country:US
Practice Address - Phone:314-371-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-08
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013026259261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health