# WALLGREENS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154604841
- **Authorized official:** CONJA SO-ROSILLO PHARMD (PHARMACIST)
- **Authorized official phone:** (650) 637-9777

## Contact information

- **Practice address:** 1414 EL CAMINO REAL, SAN CARLOS, CA 94070-0000
- **Practice address phone:** (650) 637-9777
- **Practice address fax:** (650) 637-1012
- **Mailing address:** 1414 EL CAMINO REAL, SAN CARLOS, CA 94070
- **Mailing address phone:** (650) 637-9777
- **Mailing address fax:** (650) 637-1012

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QC1500X | Community Health Clinic/Center | RPH52616 | CA | Yes |

## Other

- **Enumeration date:** 09/20/2011
- **Last updated:** 09/20/2011