Provider Demographics
NPI:1669757167
Name:WALGREENS
Entity type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TENECHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:305-685-9970
Mailing Address - Street 1:750 NW 119TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2335
Mailing Address - Country:US
Mailing Address - Phone:305-685-9970
Mailing Address - Fax:305-685-8318
Practice Address - Street 1:750 NW 119TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2335
Practice Address - Country:US
Practice Address - Phone:305-685-9970
Practice Address - Fax:305-685-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-15
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0034556305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEMPLOYER NUMBER