Provider Demographics
NPI:1770864738
Name:WALGREEN'S PHARMACY
Entity type:Organization
Organization Name:WALGREEN'S PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:COLLINS
Authorized Official - Last Name:NIETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:419-474-3915
Mailing Address - Street 1:4580 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-4738
Mailing Address - Country:US
Mailing Address - Phone:419-474-3915
Mailing Address - Fax:419-474-6277
Practice Address - Street 1:4580 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4738
Practice Address - Country:US
Practice Address - Phone:419-474-3915
Practice Address - Fax:419-474-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032127173336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy