Provider Demographics
NPI:1245270420
Name:WALGREEN OF SAN PATRICIO INC
Entity type:Organization
Organization Name:WALGREEN OF SAN PATRICIO INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUONKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:847-914-3154
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:M/S 720
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-6250
Mailing Address - Country:US
Mailing Address - Phone:217-554-8964
Mailing Address - Fax:217-554-8546
Practice Address - Street 1:CALLE 1 & CARR 3
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00627
Practice Address - Country:US
Practice Address - Phone:787-256-2626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREEN CO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-07
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4018671OtherNCPDP
4018671OtherNCPDP