Provider Demographics
NPI:1821290610
Name:WAL-MART ASSOCIATES INC.
Entity Type:Organization
Organization Name:WAL-MART ASSOCIATES INC.
Other - Org Name:WAL-MART PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:865-690-6401
Mailing Address - Street 1:8445 WALBROOK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3115
Mailing Address - Country:US
Mailing Address - Phone:865-690-6401
Mailing Address - Fax:865-690-6083
Practice Address - Street 1:8445 WALBROOK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-3115
Practice Address - Country:US
Practice Address - Phone:865-690-6401
Practice Address - Fax:865-690-6083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy