Provider Demographics
NPI:1578010583
Name:WALMART PHARMACY
Entity Type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:VINH
Authorized Official - Middle Name:CONG
Authorized Official - Last Name:BUI
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:318-640-8282
Mailing Address - Street 1:3636 MONROE HWY
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71360-4127
Mailing Address - Country:US
Mailing Address - Phone:318-640-6900
Mailing Address - Fax:
Practice Address - Street 1:3636 MONROE HWY
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71360-4127
Practice Address - Country:US
Practice Address - Phone:318-640-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017879261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health