Provider Demographics
NPI:1912308289
Name:WALMART PHARMACY #2836
Entity Type:Organization
Organization Name:WALMART PHARMACY #2836
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:919-567-9130
Mailing Address - Street 1:1051 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-1799
Mailing Address - Country:US
Mailing Address - Phone:919-567-9130
Mailing Address - Fax:919-567-1488
Practice Address - Street 1:1051 E BROAD ST
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-1799
Practice Address - Country:US
Practice Address - Phone:919-567-9130
Practice Address - Fax:919-567-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12286183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty