Healthcare Provider Details

I. General information

NPI: 1497123624
Provider Name (Legal Business Name): WALMART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2015
Last Update Date: 09/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 COLONY ST
BAKERSFIELD CA
93307-6538
US

IV. Provider business mailing address

6225 COLONY ST
BAKERSFIELD CA
93307-6538
US

V. Phone/Fax

Practice location:
  • Phone: 661-832-7997
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number65121
License Number StateCA

VIII. Authorized Official

Name: SALLY AZIZ
Title or Position: PHARMACIST
Credential:
Phone: 661-832-7997