Provider Demographics
NPI:1730557331
Name:WALMART PHARMACY #0914
Entity type:Organization
Organization Name:WALMART PHARMACY #0914
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT PHARMACY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:417-847-3180
Mailing Address - Street 1:1401 OLD EXETER RD
Mailing Address - Street 2:
Mailing Address - City:CASSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65625-9415
Mailing Address - Country:US
Mailing Address - Phone:417-847-3180
Mailing Address - Fax:417-847-3650
Practice Address - Street 1:1401 OLD EXETER RD
Practice Address - Street 2:
Practice Address - City:CASSVILLE
Practice Address - State:MO
Practice Address - Zip Code:65625-9415
Practice Address - Country:US
Practice Address - Phone:417-847-3180
Practice Address - Fax:417-847-3650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0406603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy