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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
1183500000XPharmacistPH60031151WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PH60031151OTHERWAPHARMACIST LICENSE

General Provider Information

NPI Number : 1669871869
Entity Type Code : Organization
Provider Name (Legal Business Name) : WALMART
Provider Business Mailing Address
First Line : 6690 REGENCY DR SE
Second Line : NONE
City : PORT ORCHARD
State : WA
Zip : 98367-9514
Country : US
Telephone Number : 253-509-2176
Fax Number :
Provider Business Practice Location Address
First Line : 3497 BETHEL RD SE
Second Line :
City : PORT ORCHARD
State : WA
Zip : 98366-5634
Country : US
Telephone Number : 360-874-9063
Fax Number : 360-874-0071
Authorized Official
Title or Position : PHARMACIST
Name : MICAJAH JENKINS
Credential :
Telephone Number : 253-509-2176
Provider Enumeration Date : 08/14/2014
Last Update Date : 08/14/2014

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Directions to “WALMART ” Practice Location

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