Walgreens Pharmacy

Primary specialty

Health Maintenance OrganizationTaxonomy code 302R00000X

Legal business name

WALGREENS PHARMACY

Practice address

4415 N Stateline Ave
Texarkana, TX 75503-3138

Phone

(903) 795-8918

Fax

(903) 792-6198

NPI assigned

Nov 20, 2009

Organization subpart

No

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

Authorized official

Name

Mr. Joe N Fant, BS

Title

Pharmacist

Phone

(903) 792-8918

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1258675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258675200000",
    "number": "1578891016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4415 N STATELINE AVE",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033138",
            "telephone_number": "903-795-8918",
            "fax_number": "903-792-6198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 N STATELINE AVE",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755033138",
            "telephone_number": "903-795-8918",
            "fax_number": "903-792-6198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALGREENS PHARMACY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-20",
        "last_updated": "2009-11-20",
        "status": "A",
        "authorized_official_last_name": "FANT",
        "authorized_official_first_name": "JOE",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "903-792-8918",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "183500000X",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores Texas, LLC
• Wal-Mart Stores Texas, LP
• Walgreen Co
• Walgreen Co
• Walgreen Co
• Casey L Walker
• Sade Monchique Walker
• William Todd Wallace, PT
• Cody Lee Walls, ATC, LAT, EMT
• Zachary David Walsh, PT

• Health Maintenance Organization in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Health Maintenance Organization in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2009; 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.