Provider Demographics
NPI:1053694158
Name:WALGREENS
Entity type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:636-978-8581
Mailing Address - Street 1:1490 MEXICO LOOP RD E
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-6015
Mailing Address - Country:US
Mailing Address - Phone:636-978-1602
Mailing Address - Fax:636-978-8432
Practice Address - Street 1:106 HUNTINGTON CROSSING DR
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63376-4271
Practice Address - Country:US
Practice Address - Phone:636-978-8581
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043353183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty