Organization
WALGREEN EASTERN CO INC
Active
Parent organization
WALGREEN CO
Other names
ELECTRIC BOAT PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WALGREEN CO
Authorized official
KIRA TAYLOR (MANAGER)
(217) 709-2351
Entity
Organization
Contact information
Practice address
100 ROMANO VINEYARD WAY, NORTH KINGSTOWN, RI 02852
(401) 295-5791
(401) 295-5872
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
PHA00506
RI
3336M0003X
Managed Care Organization Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4106971
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
08/29/2007
Last updated
05/06/2022
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