Provider Demographics
NPI:1427501279
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:KWADWO
Authorized Official - Middle Name:
Authorized Official - Last Name:SARFO KANTANKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-763-1561
Mailing Address - Street 1:1401 E NAVAJO DR APT 3104
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9463
Mailing Address - Country:US
Mailing Address - Phone:443-763-1561
Mailing Address - Fax:
Practice Address - Street 1:1401 E NAVAJO DR
Practice Address - Street 2:APT 3104
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9433
Practice Address - Country:US
Practice Address - Phone:443-763-1561
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMIN00003920333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy