Provider Demographics
NPI:1982395125
Name:WALGREENS HEALTH MEDICAL GROUP CALIFORNIA P.C.
Entity Type:Organization
Organization Name:WALGREENS HEALTH MEDICAL GROUP CALIFORNIA P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SASHIDARAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOODLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-399-6989
Mailing Address - Street 1:108 WILMOT RD
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60015-5145
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 WILMOT RD
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5145
Practice Address - Country:US
Practice Address - Phone:312-399-6989
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center