Walter Lagestee Incorporated

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

054-11904 Issued in IL

Legal business name

WALTER LAGESTEE INCORPORATED

Doing business as

Walt's Pharmacy #1

Practice address

16145 S State St
South Holland, IL 60473-1237

Phone

(708) 333-4492

Fax

(708) 333-8713

NPI assigned

Oct 26, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Patrick J Egan, PHARMACIST

Title

Third Party Coordinator

Phone

(708) 957-2974

Specialties & licenses 1

Addresses

Other names 1

• Walt's Pharmacy #1 Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353369600000",
    "number": "1568547594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16145 STATE ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731287",
            "telephone_number": "708-333-4492",
            "fax_number": "708-333-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16145 S STATE ST",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731237",
            "telephone_number": "708-333-4492",
            "fax_number": "708-333-8713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTER LAGESTEE INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-11-20",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "THIRD PARTY COORDINATOR",
        "authorized_official_telephone_number": "708-957-2974",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHARMACIST"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "IL",
            "license": "054-11904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walt's Pharmacy #1",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Angella Webb, RN, MSN, FNP-BC

• Community/Retail Pharmacy in South Holland, IL
• Providers in South Holland, IL by specialty
• Community/Retail Pharmacy in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.