Provider Demographics
NPI:1255615332
Name:WALGREENS PHARMACY
Entity type:Organization
Organization Name:WALGREENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARAGIANIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-478-9114
Mailing Address - Street 1:91 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-3008
Mailing Address - Country:US
Mailing Address - Phone:508-478-9114
Mailing Address - Fax:508-478-5682
Practice Address - Street 1:91 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-3008
Practice Address - Country:US
Practice Address - Phone:508-478-9114
Practice Address - Fax:508-478-5682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABW34041243336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0440299Medicaid