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General NPI Number Information
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NPI Number | 1801261359
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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 | 12/09/2015
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Last Update Date | 12/09/2015
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Provider Practice Location Address
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Address Line | 1424 W 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-3232
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Country | US
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Telephone | 773-475-4462
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Fax | 773-475-4463
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Provider Business Mailing Address
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Address Line | 1424 W 47TH ST
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City | CHICAGO
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State | IL
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Zip | 60609-3232
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Country | US
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Telephone | 773-475-4462
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Fax | 773-475-4463
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Authorized Official
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Title or Position | PHARMACY CLINICAL SERVICES MANAGER
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Name | DR. MARIA C TANGONAN
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Credential | PHARMD
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Telephone | 708-890-0106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 051297740
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License Number State | IL
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