Provider Demographics
NPI:1790228146
Name:WALGREENS
Entity type:Organization
Organization Name:WALGREENS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REGISTERED PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIGHT
Authorized Official - Middle Name:NII LANTE
Authorized Official - Last Name:LAMPTEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:571-331-1893
Mailing Address - Street 1:600 J CLYDE MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1820
Mailing Address - Country:US
Mailing Address - Phone:757-599-6264
Mailing Address - Fax:
Practice Address - Street 1:99 TIDE MILL LN
Practice Address - Street 2:APT #96
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-2764
Practice Address - Country:US
Practice Address - Phone:571-331-1893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214980302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization