Provider Demographics
NPI:1356623920
Name:WALGREENS 4876
Entity type:Organization
Organization Name:WALGREENS 4876
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SZELIGA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:732-287-3652
Mailing Address - Street 1:905 NEW DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2253
Mailing Address - Country:US
Mailing Address - Phone:732-287-3652
Mailing Address - Fax:732-287-3877
Practice Address - Street 1:905 NEW DURHAM RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2253
Practice Address - Country:US
Practice Address - Phone:732-287-3652
Practice Address - Fax:732-287-3877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy