Provider Demographics
NPI:1427690007
Name:WALMART PHARMACY
Entity type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY INTERN
Authorized Official - Prefix:
Authorized Official - First Name:XHOVANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-258-5416
Mailing Address - Street 1:3845 E KINGS AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3268
Mailing Address - Country:US
Mailing Address - Phone:480-258-5416
Mailing Address - Fax:
Practice Address - Street 1:15355 N NORTHSIGHT BLVD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2603
Practice Address - Country:US
Practice Address - Phone:480-348-0401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy