Provider Demographics
NPI:1487013033
Name:WALMART
Entity Type:Organization
Organization Name:WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.PH.
Authorized Official - Prefix:
Authorized Official - First Name:MELEHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRAUENHOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:972-202-4007
Mailing Address - Street 1:1400 MCCREARY RD
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8776
Mailing Address - Country:US
Mailing Address - Phone:972-202-4007
Mailing Address - Fax:
Practice Address - Street 1:1400 MCCREARY RD
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-8776
Practice Address - Country:US
Practice Address - Phone:972-202-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51893183500000X
IA22672183500000X
IL51299222183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
463181OtherNABP
22672OtherIOWA STATE BOARD OF PHARMACY
TX51893OtherTEXAS STATE BOARD OF PARMACY