Organization
WALGREEN CO
Active
Parent organization
WALGREEN CO
Other names
Nissan Family Pharmacy #12952
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
300 NISSAN DR, CANTON, MS 39046-8562
(601) 407-1545
(601) 407-1550
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
3336C0003X
Community/Retail Pharmacy
Primary
05763 0.26
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2521323
NCPDP
MS
Enumeration date
01/23/2007
Last updated
04/08/2022
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