Healthcare Provider Details

I. General information

NPI: 1609325455
Provider Name (Legal Business Name): WALMART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 09/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1399 NAT WASHINGTON WAY
EPHRATA WA
98823-2629
US

IV. Provider business mailing address

1133 N GRAPE DR APT B105
MOSES LAKE WA
98837-4052
US

V. Phone/Fax

Practice location:
  • Phone: 509-754-8847
  • Fax:
Mailing address:
  • Phone: 413-386-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH60665016
License Number StateWA

VIII. Authorized Official

Name: FIONNA CHIN CHAU
Title or Position: PHARMACIST
Credential:
Phone: 413-386-7533