Provider Demographics
NPI:1730461633
Name:WALGREENS PHARMACY
Entity Type:Organization
Organization Name:WALGREENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:SRISUDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:REIMER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:858-569-1151
Mailing Address - Street 1:8766 NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-2722
Mailing Address - Country:US
Mailing Address - Phone:619-667-8764
Mailing Address - Fax:619-667-1208
Practice Address - Street 1:8766 NAVAJO RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-2722
Practice Address - Country:US
Practice Address - Phone:619-667-8764
Practice Address - Fax:619-667-1208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60403333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy