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General NPI Number Information
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NPI Number | 1023560166
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Entity Type | Organization
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Legal Business Name | SAM'S CLUB/WALMART
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Dates
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Enumeration Date | 10/25/2016
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Last Update Date | 10/25/2016
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Provider Practice Location Address
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Address Line | 1375 S ARIZONA AVE
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City | CHANDLER
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State | AZ
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Zip | 85286-6500
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Country | US
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Telephone | 480-364-1568
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Fax |
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Provider Business Mailing Address
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Address Line | 4038 N TERRA MESA CIR
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City | MESA
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State | AZ
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Zip | 85207-1475
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Country | US
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Telephone | 480-364-1568
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Fax |
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Authorized Official
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Title or Position | RELIEF STAFF PHARMACIST
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Name | DR. KRISTY THANHVAN TRAN
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Credential | PHARMD
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Telephone | 480-364-1568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | S013076
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License Number State | AZ
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