Provider Demographics
NPI:1083964043
Name:WALMART
Entity Type:Organization
Organization Name:WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH & WELLNESS REGIONAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SERRANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-643-7777
Mailing Address - Street 1:CARR PR 2 INTERSECCION PR 165
Mailing Address - Street 2:BO MEDIA LUNA
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-653-8031
Mailing Address - Fax:
Practice Address - Street 1:CARR PR 2 INTERSECCION PR 165
Practice Address - Street 2:BO MEDIA LUNA
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-653-8031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier