Provider Demographics
NPI:1770936502
Name:WALMART PHARMACY
Entity type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKYN
Authorized Official - Middle Name:ASHLEIGH
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD, RPH, MA
Authorized Official - Phone:318-609-2101
Mailing Address - Street 1:2491 HIGHWAY 120
Mailing Address - Street 2:
Mailing Address - City:ROBELINE
Mailing Address - State:LA
Mailing Address - Zip Code:71469-5509
Mailing Address - Country:US
Mailing Address - Phone:318-609-2101
Mailing Address - Fax:
Practice Address - Street 1:2491 HIGHWAY 120
Practice Address - Street 2:
Practice Address - City:ROBELINE
Practice Address - State:LA
Practice Address - Zip Code:71469-5509
Practice Address - Country:US
Practice Address - Phone:318-609-2101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPST.0213863336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy