Healthcare Provider Details

I. General information

NPI: 1689065419
Provider Name (Legal Business Name): WALMART PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 SAM HOUSTON JONES PKWY
MOSS BLUFF LA
70611-5603
US

IV. Provider business mailing address

260 SAM HOUSTON JONES PKWY
MOSS BLUFF LA
70611-5603
US

V. Phone/Fax

Practice location:
  • Phone: 337-214-6402
  • Fax:
Mailing address:
  • Phone: 337-214-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number016829
License Number StateLA

VIII. Authorized Official

Name: MRS. JODY ARNOLD
Title or Position: STAFF PHARMACIST
Credential: RPH, PD
Phone: 337-905-4031