Healthcare Provider Details

I. General information

NPI: 1982645495
Provider Name (Legal Business Name): WALMART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2399 N POINT BLVD
DUNDALK MD
21222-1623
US

IV. Provider business mailing address

2399 N POINT BLVD
DUNDALK MD
21222-1623
US

V. Phone/Fax

Practice location:
  • Phone: 410-284-0126
  • Fax: 410-284-0292
Mailing address:
  • Phone: 410-284-0126
  • Fax: 410-284-0292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberBW6291001
License Number StateMD

VIII. Authorized Official

Name: LONI VANCE
Title or Position: PHARMACIST/MANAGERX
Credential: PHD
Phone: 410-284-0126