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Organization
WALGREENS PHARMACY
Active
Organization
WALGREENS PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOE N FANT BS (PHARMACIST)
(903) 792-8918
Entity
Organization
Contact information
Practice address
4415 N STATELINE AVE, TEXARKANA, TX 75503-3138
(903) 795-8918
(903) 792-6198
Mailing address
4415 N STATELINE AVE, TEXARKANA, TX 75503-3138
(903) 795-8918
(903) 792-6198
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
183500000X
—
TX
Enumeration date
11/20/2009
Last updated
11/20/2009
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