| Organization Name: | WALMART PHARMACY #1070 |
| NPI Number: | 1629480298 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROBYN CARTER (STAFF PHARMACIST) |
| Mailing Address: | 88 Highland Xing East Ellijay |
| State: | GA US |
| Postal Code: | 305406052 |
| Phone Number: | 7062761180 |
| Fax Number: | |
| NPI Enumeration Date: | 05/29/2014 |
| NPI Last Update Date: | 05/29/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QC1500X |
| License Number: | 12398 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Community Health |
| Taxonomy Definition: | |