Provider Demographics
NPI:1750700753
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:KENNETH
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:678-472-2971
Mailing Address - Street 1:390 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3666
Mailing Address - Country:US
Mailing Address - Phone:478-237-0788
Mailing Address - Fax:
Practice Address - Street 1:390 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3666
Practice Address - Country:US
Practice Address - Phone:478-237-0788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027064261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care