Provider Demographics
NPI:1952685737
Name:WALGREENS 9810
Entity Type:Organization
Organization Name:WALGREENS 9810
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHA;RMACIST8303723360
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:ACUNA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:830-372-3360
Mailing Address - Street 1:1357 E COURT ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-5130
Mailing Address - Country:US
Mailing Address - Phone:830-372-3360
Mailing Address - Fax:
Practice Address - Street 1:1357 E COURT ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-5130
Practice Address - Country:US
Practice Address - Phone:830-372-3360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17099305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service