Provider Demographics
NPI:1942624457
Name:WALGREENS
Entity Type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AWUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:ASONG
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:508-498-7053
Mailing Address - Street 1:2051 W CUMBERLAND RD
Mailing Address - Street 2:APT 1113
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-5343
Mailing Address - Country:US
Mailing Address - Phone:508-498-7053
Mailing Address - Fax:
Practice Address - Street 1:2201 S LOOP 256
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-4701
Practice Address - Country:US
Practice Address - Phone:903-723-4705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health