1215195730 NPI number — WALGREEN MEDICAL SUPPLY LLC

Table of content: (NPI 1215195730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215195730 NPI number — WALGREEN MEDICAL SUPPLY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALGREEN MEDICAL SUPPLY LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215195730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1901 E VOORHEES ST
Provider Second Line Business Mailing Address:
MS 790
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61834-4509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-709-2494
Provider Business Mailing Address Fax Number:
217-709-2344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18861 90TH AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MOKENA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60448-8178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-390-5858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NIELSEN
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
Authorized Official Title or Position:
TREASURER
Authorized Official Telephone Number:
847-315-3523

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215195730 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200239190A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54980071 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008031923 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2978649 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 391322 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8083274 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2157141 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100261888 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023082210001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2000005 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215195730 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215195730 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200911480A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215195730 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215195730 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215195730 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1574610 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1215195730 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100154440 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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