Organization
WALGREEN CO
Active
Parent organization
WALGREEN CO
Other names
Fieldale Farms Family Health Care Center & 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
184 PROFESSIONAL DR UNIT B, BALDWIN, GA 30511-4012
(866) 894-2283
(706) 894-2717
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
PHRE008894
GA
3336M0003X
Managed Care Organization Pharmacy
Primary
PHRE008894
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1152684
NCPDP NO.
—
01
—
PHRE008894
STATE LICENSE NO.
GA
Enumeration date
02/20/2007
Last updated
03/07/2023
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