Provider Demographics
NPI:1578937942
Name:WALMART PHARMACY 10 0764
Entity Type:Organization
Organization Name:WALMART PHARMACY 10 0764
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:205-424-5895
Mailing Address - Street 1:750 ACADEMY DR
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5200
Mailing Address - Country:US
Mailing Address - Phone:205-424-5895
Mailing Address - Fax:205-424-5897
Practice Address - Street 1:750 ACADEMY DR
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5200
Practice Address - Country:US
Practice Address - Phone:205-424-5895
Practice Address - Fax:205-424-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-21
Last Update Date:2015-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL171143336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy