Healthcare Provider Details

I. General information

NPI: 1376943373
Provider Name (Legal Business Name): WALMART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2014
Last Update Date: 08/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 N AIRPORT RD
WILLOWS CA
95988-9701
US

IV. Provider business mailing address

470 N AIRPORT RD
WILLOWS CA
95988-9701
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-2042
  • Fax: 530-934-2021
Mailing address:
  • Phone: 530-934-2042
  • Fax: 530-934-2021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number63611
License Number StateCA

VIII. Authorized Official

Name: JEVONNE SERVICE
Title or Position: MARKET DIRECTOR
Credential: PHARMD
Phone: 479-295-1552