Provider Demographics
NPI:1205289121
Name:WALGREENS PHARMACY
Entity type:Organization
Organization Name:WALGREENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGER
Authorized Official - Prefix:
Authorized Official - First Name:SHENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-353-8026
Mailing Address - Street 1:10580 W USTICK RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-5267
Mailing Address - Country:US
Mailing Address - Phone:208-377-3581
Mailing Address - Fax:
Practice Address - Street 1:10580 W USTICK RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-5267
Practice Address - Country:US
Practice Address - Phone:208-377-3581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPP7517251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management