Provider Demographics
NPI:1720363708
Name:WALGREEN
Entity Type:Organization
Organization Name:WALGREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAHRMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOUMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAS
Authorized Official - Suffix:I
Authorized Official - Credentials:RPH
Authorized Official - Phone:916-722-1982
Mailing Address - Street 1:7787 SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-2309
Mailing Address - Country:US
Mailing Address - Phone:916-722-1982
Mailing Address - Fax:
Practice Address - Street 1:7787 SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:CITRUS HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:95610-2309
Practice Address - Country:US
Practice Address - Phone:916-722-1982
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59342183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty