Provider Information for 1568004216
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WALMART INC
Other Names:Doing Business As:WALMART PHARMACY 10-5140Organization Subpart: NO
NPI: 1568004216
Last Updated: 2023-08-30
Certification Date: 2023-08-30
Certification Date: 2023-08-30
Details
Name | Value | ||||||||||||||
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NPI | 1568004216 | ||||||||||||||
Enumeration Date | 2019-10-15 | ||||||||||||||
NPI Type | NPI-2 Organization | ||||||||||||||
Status | Active | ||||||||||||||
Authorized Official Information | Name: SARAH LITTLE Title: Dir Healthcare Contracting Phone: 4792772500 | ||||||||||||||
Mailing Address | 702 SW 8TH ST BENTONVILLE, AR 72716-0445 United States Phone: 479-258-2115 | Fax:479-277-4331 | ||||||||||||||
Primary Practice Address | 5500 GROSSMONT CENTER DR LA MESA, CA 91942-3016 United States Phone: 619-315-0002 | Fax:619-315-0003 | ||||||||||||||
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