Provider Demographics
NPI:1609325455
Name:WALMART
Entity Type:Organization
Organization Name:WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:FIONNA
Authorized Official - Middle Name:CHIN
Authorized Official - Last Name:CHAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-386-7533
Mailing Address - Street 1:1133 N GRAPE DR
Mailing Address - Street 2:APT B105
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-4052
Mailing Address - Country:US
Mailing Address - Phone:413-386-7533
Mailing Address - Fax:
Practice Address - Street 1:1399 NAT WASHINGTON WAY
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:WA
Practice Address - Zip Code:98823-2629
Practice Address - Country:US
Practice Address - Phone:509-754-8847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH606650163336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy