Provider Demographics
NPI:1366895104
Name:WALMART
Entity type:Organization
Organization Name:WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHWD
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRILO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-418-6159
Mailing Address - Street 1:13425 COMMUNITY RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4723
Mailing Address - Country:US
Mailing Address - Phone:858-486-1801
Mailing Address - Fax:858-486-1803
Practice Address - Street 1:13425 COMMUNITY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4723
Practice Address - Country:US
Practice Address - Phone:858-486-1801
Practice Address - Fax:858-486-1803
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
CA63867183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty