Provider Demographics
NPI:1982645495
Name:WALMART
Entity Type:Organization
Organization Name:WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST/MANAGERX
Authorized Official - Prefix:
Authorized Official - First Name:LONI
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-284-0126
Mailing Address - Street 1:2399 N POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:DUNDALK
Mailing Address - State:MD
Mailing Address - Zip Code:21222-1623
Mailing Address - Country:US
Mailing Address - Phone:410-284-0126
Mailing Address - Fax:410-284-0292
Practice Address - Street 1:2399 N POINT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-1623
Practice Address - Country:US
Practice Address - Phone:410-284-0126
Practice Address - Fax:410-284-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBW6291001333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy