Provider Demographics
NPI:1457373920
Name:HAPPY HARRYS INC
Entity Type:Organization
Organization Name:HAPPY HARRYS INC
Other - Org Name:WALGREENS #11079
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-709-2351
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS #790
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:217-709-2351
Mailing Address - Fax:217-709-2344
Practice Address - Street 1:38627 BENRO DR UNIT 1
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:DE
Practice Address - Zip Code:19940-3572
Practice Address - Country:US
Practice Address - Phone:302-907-1010
Practice Address - Fax:302-907-1006
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREENS BOOTS ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0003X
DEA3-0000862333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
0844781OtherOTHER ID
DE1457373920Medicaid
MD412632700Medicaid
MD412630100OtherMEDICAID DME
DE0602210081Medicare NSC
P00400633Medicare PIN
DE1457373920Medicaid
MD412632700Medicaid
MD412630100OtherMEDICAID DME
0844781OtherOTHER ID