Provider Demographics
NPI:1104125574
Name:WALGREENS
Entity type:Organization
Organization Name:WALGREENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST- MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:718-926-3432
Mailing Address - Street 1:1091 ROSEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7807
Mailing Address - Country:US
Mailing Address - Phone:718-926-3432
Mailing Address - Fax:
Practice Address - Street 1:7151 BLVD 26
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8607
Practice Address - Country:US
Practice Address - Phone:817-514-9474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREENS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX473433336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy