Provider Demographics
NPI:1699058149
Name:WALGREENS DRUG STORE
Entity type:Organization
Organization Name:WALGREENS DRUG STORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUKS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:317-351-5973
Mailing Address - Street 1:5460 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6449
Mailing Address - Country:US
Mailing Address - Phone:317-351-5973
Mailing Address - Fax:317-351-8781
Practice Address - Street 1:5460 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6449
Practice Address - Country:US
Practice Address - Phone:317-351-5973
Practice Address - Fax:317-351-8781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26015312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty