MEDICARE: WAL-MART ASSOCIATES INC.

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
1	3336C0003X	Community/Retail Pharmacy		TN

General Provider Information

NPI Number	:	1821290610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAL-MART ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	8445 WALBROOK DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-3115
Country	:	US
Telephone Number	:	865-690-6401
Fax Number	:	865-690-6083

Provider Business Practice Location Address
First Line	:	8445 WALBROOK DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-3115
Country	:	US
Telephone Number	:	865-690-6401
Fax Number	:	865-690-6083

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	DR. ANNE E WHITEHEAD
Credential	:	PHARM.D
Telephone Number	:	865-690-6401

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	08/22/2020

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