Provider Demographics
NPI:1205103025
Name:WALGREENS
Entity type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KASPER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:773-434-3621
Mailing Address - Street 1:7901 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-5912
Mailing Address - Country:US
Mailing Address - Phone:773-434-3621
Mailing Address - Fax:773-434-4253
Practice Address - Street 1:7901 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-5912
Practice Address - Country:US
Practice Address - Phone:773-434-3621
Practice Address - Fax:773-434-4253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051-026562333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL362127039139Medicaid