Provider Demographics
NPI:1215195730
Name:WALGREEN MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:WALGREEN MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-315-3523
Mailing Address - Street 1:1901 E VOORHEES ST
Mailing Address - Street 2:MS 790
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61834-4509
Mailing Address - Country:US
Mailing Address - Phone:217-709-2494
Mailing Address - Fax:217-709-2344
Practice Address - Street 1:18861 90TH AVE
Practice Address - Street 2:SUITE D
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-8178
Practice Address - Country:US
Practice Address - Phone:708-390-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALGREENS BOOTS ALLIANCE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-30
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215195730Medicaid
OK200239190AMedicaid
NM54980071Medicaid
CT008031923Medicaid
OH2978649Medicaid
AZ391322Medicaid
ID8083274Medicaid
LA2157141Medicaid
NE100261888Medicaid
PA1023082210001Medicaid
SD2000005Medicaid
IA1215195730Medicaid
VA1215195730Medicaid
IN200911480AMedicaid
MN1215195730Medicaid
MO1215195730Medicaid
CA1215195730Medicaid
AK1574610Medicaid
WI1215195730Medicaid
KY7100154440Medicaid
CT008031923Medicaid
MO1215195730Medicaid