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General NPI Number Information
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NPI Number | 1750785127
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Entity Type | Organization
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Legal Business Name | WALMART 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 | 3812 LIBERTY HWY
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City | ANDERSON
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State | SC
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Zip | 29621-1344
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Country | US
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Telephone | 864-231-6071
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Fax | 864-231-6073
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Provider Business Mailing Address
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Address Line | 3812 LIBERTY HWY
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City | ANDERSON
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State | SC
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Zip | 29621
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Country | US
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Telephone | 864-231-6071
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Fax | 864-231-6073
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Authorized Official
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Title or Position | PHARMACIST
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Name | MR. DENNIS VAN PETERSON
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Credential | R.PH.
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Telephone | 864-231-6071
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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 | 05847
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License Number State | SC
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