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General NPI Number Information
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NPI Number | 1043681745
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Entity Type | Organization
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Legal Business Name | WALMART PHARMACY
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 10/07/2015
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Provider Practice Location Address
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Address Line | 443 OSBORN AVE
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City | BIGFORK
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State | MT
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Zip | 59911-3671
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Country | US
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Telephone | 207-864-5773
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Fax |
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Provider Business Mailing Address
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Address Line | 36318 MEMORY LN
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City | POLSON
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State | MT
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Zip | 59860-7265
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Country | US
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Telephone | 406-883-9221
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Fax | 406-883-9341
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | MR. DAVID PAUL HEBERT
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Credential | RPH
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Telephone | 406-883-9221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 21696
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License Number State | MT
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