Provider Demographics
NPI:1548719040
Name:WALMART PHARMACY
Entity type:Organization
Organization Name:WALMART PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:MORTEZA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARHIZKAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:505-506-8660
Mailing Address - Street 1:2428 WINDWARD DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3698
Mailing Address - Country:US
Mailing Address - Phone:505-506-8660
Mailing Address - Fax:
Practice Address - Street 1:301 SAN MATEO BLVD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5629
Practice Address - Country:US
Practice Address - Phone:505-262-1915
Practice Address - Fax:505-268-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-25
Last Update Date:2016-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRP00008596282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital