Provider Demographics
NPI:1053786749
Name:WALGREENS PHARMACY
Entity type:Organization
Organization Name:WALGREENS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:MISKOV
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:440-452-5731
Mailing Address - Street 1:PO BOX 80263
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89180-0263
Mailing Address - Country:US
Mailing Address - Phone:440-452-5731
Mailing Address - Fax:
Practice Address - Street 1:5888 W SUNSET RD STE 200
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-3453
Practice Address - Country:US
Practice Address - Phone:702-585-2890
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV191933336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV19193OtherNEVADA BOARD OF PHARMACY