=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487013033
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALMART
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2016
-----------------------------------------------------
Last Update Date | 02/10/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1400 MCCREARY RD
-----------------------------------------------------
City | WYLIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75098-8776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-202-4007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1400 MCCREARY RD
-----------------------------------------------------
City | WYLIE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75098-8776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-202-4007
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | R.PH.
-----------------------------------------------------
Name | MELEHIA ANN FRAUENHOLTZ
-----------------------------------------------------
Credential | PHARM.D
-----------------------------------------------------
Telephone | 972-202-4007
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 22672
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 51299222
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 51893
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------