Provider Demographics
NPI:1467828764
Name:WAL-MART
Entity Type:Organization
Organization Name:WAL-MART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:CARMEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SITU
Authorized Official - Suffix:
Authorized Official - Credentials:RPM
Authorized Official - Phone:626-814-4790
Mailing Address - Street 1:3250 BIG DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706
Mailing Address - Country:US
Mailing Address - Phone:626-814-4790
Mailing Address - Fax:
Practice Address - Street 1:3250 BIG DALTON AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5107
Practice Address - Country:US
Practice Address - Phone:626-814-4790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy