Provider Demographics
NPI:1629487616
Name:WALMART PHARMACY
Entity Type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:NWAKAEGO
Authorized Official - Last Name:ANYANWU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-880-3652
Mailing Address - Street 1:4001 HALLMARK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1876
Mailing Address - Country:US
Mailing Address - Phone:909-880-3652
Mailing Address - Fax:
Practice Address - Street 1:4001 HALLMARK PKWY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-1876
Practice Address - Country:US
Practice Address - Phone:909-880-3652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66773251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health