Provider Demographics
NPI:1194092932
Name:WALGREEN
Entity type:Organization
Organization Name:WALGREEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:RIBHI
Authorized Official - Last Name:ALSHARKAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-334-1080
Mailing Address - Street 1:4901 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-2901
Mailing Address - Country:US
Mailing Address - Phone:262-886-9643
Mailing Address - Fax:
Practice Address - Street 1:4901 SPRING ST
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-2901
Practice Address - Country:US
Practice Address - Phone:262-886-9643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIBW9280621OtherDEA