Provider Demographics
NPI:1629480298
Name:WALMART PHARMACY #1070
Entity Type:Organization
Organization Name:WALMART PHARMACY #1070
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:706-502-2374
Mailing Address - Street 1:405 RIVEREDGE LN # 9061
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-5390
Mailing Address - Country:US
Mailing Address - Phone:706-502-2374
Mailing Address - Fax:
Practice Address - Street 1:88 HIGHLAND XING
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-6052
Practice Address - Country:US
Practice Address - Phone:706-276-1180
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12398261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health