# WALTER LAGESTEE INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walt's Pharmacy \#1
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568547594
- **Authorized official:** MR. PATRICK J EGAN PHARMACIST (THIRD PARTY COORDINATOR)
- **Authorized official phone:** (708) 957-2974

## Contact information

- **Practice address:** 16145 S STATE ST, SOUTH HOLLAND, IL 60473-1237
- **Practice address phone:** (708) 333-4492
- **Practice address fax:** (708) 333-8713
- **Mailing address:** 16145 STATE ST, SOUTH HOLLAND, IL 60473-1287
- **Mailing address phone:** (708) 333-4492
- **Mailing address fax:** (708) 333-8713

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3336C0003X | Community/Retail Pharmacy | 054-11904 | IL | Yes |

## Other

- **Enumeration date:** 10/26/2006
- **Last updated:** 11/20/2012