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NPI Code Detail

MEDICARE: WALMART

MEDICARE: WALMART
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center74600CA

General Provider Information

NPI Number : 1114477379
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALMART
Provider Business Mailing Address
First Line : 6250 VALLEY SPRINGS PKWY
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-0970
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6250 VALLEY SPRINGS PKWY
Second Line :
City : RIVERSIDE
State : CA
Zip : 92507-0970
Country : US
Telephone Number : 951-653-2969
Fax Number :
Authorized Official
Title or Position : RPH
Name : KATHY BUI
Credential : PHARMD
Telephone Number : 714-717-7068
Provider Enumeration Date : 10/11/2016
Last Update Date : 10/11/2016

Similar Medicare Providers

1588681902 — WALMART INC.
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6250 VALLEY SPRINGS PKWY
RIVERSIDE, CA
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1275030520 — VIVIAN VAN NGUYEN
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1184111320 — KYUNG MIN PHARMD
Practice Location Address:
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92507-0970
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Directions to “WALMART ” Practice Location

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