Organization Name: | WALGREENS 11079 |
NPI Number: | 1023455383 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JON REITZ (MARKET PHARMACY DIRECTOR) |
Mailing Address: | 38627 Benro Dr Delmar |
State: | DE US |
Postal Code: | 199403572 |
Phone Number: | 3029071010 |
Fax Number: | 3029071006 |
NPI Enumeration Date: | 05/28/2013 |
NPI Last Update Date: | 05/28/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | 380101061159913 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DE |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |