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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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