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General NPI Number Information
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NPI Number | 1982158622
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Entity Type | Organization
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Legal Business Name | WAL-MART PHARMACY
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Dates
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Enumeration Date | 08/11/2016
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Last Update Date | 08/11/2016
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Provider Practice Location Address
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Address Line | 4875 OLD YORK RD
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City | ROCK HILL
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State | SC
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Zip | 29732-8127
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Country | US
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Telephone | 803-323-2091
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Fax |
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Provider Business Mailing Address
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Address Line | 4875 OLD YORK RD
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City | ROCK HILL
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State | SC
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Zip | 29732-8127
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Country | US
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Telephone | 803-323-2091
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Fax |
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Authorized Official
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Title or Position | STAFF PHARMACIST
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Name | ADRIANA RENEE HOUSTON
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Credential | PHARMD
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Telephone | 803-381-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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