Organization
WALGREEN CO
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens # 11795
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALGREENS BOOTS ALLIANCE INC
Authorized official
KIRA L TAYLOR (MANAGER)
(217) 709-2351
Entity
Organization
Contact information
Practice address
3551 CASSOPOLIS ST, ELKHART, IN 46514-6743
(574) 206-0285
(574) 266-5819
Mailing address
1901 E VOORHEES ST, MS #790, DANVILLE, IL 61834-4509
(217) 709-2351
(217) 709-2344
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
60006128A
IN
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1562075
NABP
IN
01
—
1562075
MEDICAID MI
MI
05
—
200900300A
—
IN
Enumeration date
04/25/2008
Last updated
11/03/2023
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