Provider Demographics
NPI:1811397656
Name:WALMART PHARMACY
Entity Type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OTOVWE
Authorized Official - Middle Name:
Authorized Official - Last Name:EDUVIE-KELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-669-5309
Mailing Address - Street 1:4808 ODIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70126-2322
Mailing Address - Country:US
Mailing Address - Phone:504-669-5309
Mailing Address - Fax:
Practice Address - Street 1:8912 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003
Practice Address - Country:US
Practice Address - Phone:504-465-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019014183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty