Provider Demographics
NPI:1861975807
Name:WALMART
Entity type:Organization
Organization Name:WALMART
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:GENAVIVE
Authorized Official - Last Name:ZARZECKI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:443-703-8965
Mailing Address - Street 1:25 RIVER ST APT 242
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-3089
Mailing Address - Country:US
Mailing Address - Phone:443-703-8965
Mailing Address - Fax:
Practice Address - Street 1:1636 SANDIFER BLVD
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-0906
Practice Address - Country:US
Practice Address - Phone:864-885-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy