Provider Demographics
NPI:1679890396
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RPH
Authorized Official - Prefix:
Authorized Official - First Name:DIEM
Authorized Official - Middle Name:KHANH
Authorized Official - Last Name:NGUYYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-355-4831
Mailing Address - Street 1:2050 LONG PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4221
Mailing Address - Country:US
Mailing Address - Phone:972-355-4831
Mailing Address - Fax:972-355-4482
Practice Address - Street 1:2908 EASTBOURNE LN
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-0900
Practice Address - Country:US
Practice Address - Phone:972-874-8496
Practice Address - Fax:972-874-8496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33504183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty