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General NPI Number Information
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NPI Number | 1679955504
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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 | 06/27/2015
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Last Update Date | 06/27/2015
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Provider Practice Location Address
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Address Line | 7575 W LOWER BUCKEYE RD
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City | PHOENIX
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State | AZ
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Zip | 85043-3450
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Country | US
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Telephone | 623-907-0712
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Fax |
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Provider Business Mailing Address
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Address Line | 21024 N 56TH AVE
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City | GLENDALE
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State | AZ
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Zip | 85308-6219
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Country | US
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Telephone | 520-971-5700
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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. MARK ANDREW EICHER
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Credential | PHARMD
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Telephone | 623-907-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | S020800
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License Number State | AZ
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