Healthcare Provider Details

I. General information

NPI: 1649671777
Provider Name (Legal Business Name): WALMART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 CERRILLOS RD PHARMACY
SANTA FE NM
87507-2924
US

IV. Provider business mailing address

3251 CERRILLOS RD PHARMACY
SANTA FE NM
87507-2924
US

V. Phone/Fax

Practice location:
  • Phone: 505-473-4261
  • Fax: 505-474-0412
Mailing address:
  • Phone: 505-473-4261
  • Fax: 505-474-0412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number7941
License Number StateNM

VIII. Authorized Official

Name: CALEDONIA HARRISON
Title or Position: RPH
Credential: PHARM.D.
Phone: 931-607-1979