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General NPI Number Information
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NPI Number | 1578004438
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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 | 03/12/2017
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Last Update Date | 03/12/2017
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Provider Practice Location Address
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Address Line | 604 N 26TH ST
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City | ARTESIA
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State | NM
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Zip | 88210-3723
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Country | US
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Telephone | 575-746-6137
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Fax |
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Provider Business Mailing Address
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Address Line | 2602 W RICHEY AVE APT 1705
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City | ARTESIA
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State | NM
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Zip | 88210-9673
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Country | US
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Telephone | 575-513-0650
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. ESEOSA EGHAREVBA
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Credential | PHARM D
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Telephone | 575-513-0650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | RP00008666
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License Number State | NM
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