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General NPI Number Information
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NPI Number | 1386048783
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Entity Type | Organization
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Legal Business Name | WAL-MART PHARMACY
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Dates
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Enumeration Date | 10/14/2014
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Last Update Date | 10/14/2014
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Provider Practice Location Address
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Address Line | 2701 LOUISVILLE AVE
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City | MONROE
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State | LA
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Zip | 71201-6128
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Country | US
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Telephone | 318-361-0690
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Fax |
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Provider Business Mailing Address
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Address Line | 2701 LOUISVILLE AVE
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City | MONROE
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State | LA
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Zip | 71201-6128
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Country | US
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Telephone | 318-361-0690
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Fax |
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Authorized Official
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Title or Position | DISTRICT MANAGER
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Name | RON FRANKLIN
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Credential |
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Telephone | 479-616-8550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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