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General NPI Number Information
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NPI Number | 1154782845
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Entity Type | Organization
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Legal Business Name | WALMART
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 03/09/2016
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Provider Practice Location Address
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Address Line | 1120 N. OPAL DR.
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City | PRESCOTT
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State | AZ
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Zip | 86303
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Country | US
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Telephone | 845-242-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 1120 N OPAL DR
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City | PRESCOTT
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State | AZ
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Zip | 86303-6215
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | ZACHARY TOMPKINS
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Credential |
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Telephone | 845-242-7811
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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 | S021763
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License Number State | AZ
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