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General NPI Number Information
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NPI Number | 1184095325
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Entity Type | Organization
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Legal Business Name | WAL-MART NEIGHBORHOOD MARKET
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Dates
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Enumeration Date | 10/14/2015
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 973 N HARRISON AVE
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City | CARY
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State | NC
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Zip | 27513-3904
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Country | US
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Telephone | 919-337-9784
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Fax | 919-337-9785
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Provider Business Mailing Address
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Address Line | 973 N HARRISON AVE
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City | CARY
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State | NC
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Zip | 27513-3904
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Country | US
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Telephone | 919-337-9784
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Fax | 919-337-9785
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | DR. LAN T LE
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Credential | PHARM.D., MBA
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Telephone | 919-337-9784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23411
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License Number State | NC
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