Provider Demographics
NPI:1811279706
Name:WALGREENS
Entity type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHANTHAKHONE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUANGDARA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:305-254-0323
Mailing Address - Street 1:11398 QUAIL ROOST DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6551
Mailing Address - Country:US
Mailing Address - Phone:305-254-0323
Mailing Address - Fax:
Practice Address - Street 1:11398 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6551
Practice Address - Country:US
Practice Address - Phone:305-254-0323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42653183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty