Provider Demographics
NPI:1831460328
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:YELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:YEVSTRATOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:813-977-0651
Mailing Address - Street 1:4703 POINT O WOODS DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6940
Mailing Address - Country:US
Mailing Address - Phone:813-298-0355
Mailing Address - Fax:
Practice Address - Street 1:4703 POINT O WOODS DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-6940
Practice Address - Country:US
Practice Address - Phone:813-298-0355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-16
Last Update Date:2012-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty