Provider Demographics
NPI:1477919595
Name:WALMART PHARMACY 0342
Entity Type:Organization
Organization Name:WALMART PHARMACY 0342
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:SCHROEDER
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:785-742-4213
Mailing Address - Street 1:701 HOPI ST
Mailing Address - Street 2:
Mailing Address - City:HIAWATHA
Mailing Address - State:KS
Mailing Address - Zip Code:66434-8929
Mailing Address - Country:US
Mailing Address - Phone:785-742-4213
Mailing Address - Fax:785-742-7699
Practice Address - Street 1:701 HOPI ST
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:KS
Practice Address - Zip Code:66434-8929
Practice Address - Country:US
Practice Address - Phone:785-742-4213
Practice Address - Fax:785-742-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-11271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty