Organization
WALGREEN CO.
Active
Parent organization
WALGREENS BOOTS ALLIANCE INC
Other names
Walgreens #12122
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
1954 SW GATLIN BLVD, PORT ST LUCIE, FL 34953-2722
(772) 224-3020
(772) 878-9388
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
PH23987
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000917500
—
FL
01
—
000917501
FL MEDICAID DME
FL
01
—
1042821
NCPDP
—
Enumeration date
02/11/2009
Last updated
03/29/2022
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