Walmart

Primary specialty

PharmacistTaxonomy code 183500000X

License

PH60031151 Issued in WA

Legal business name

WALMART

Practice address

3497 Bethel Rd SE
Port Orchard, WA 98366-5634

Phone

(360) 874-9063

Fax

(360) 874-0071

NPI assigned

Aug 14, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Micajah JenkinsNPI 1760888051

Title

Pharmacist

Phone

(253) 509-2176

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Micajah Jenkins

  • Pharmacist
  • Port Orchard, WA
  • NPI 1760888051
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1407974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407974400000",
    "number": "1669871869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6690 REGENCY DR SE",
            "address_2": "NONE",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983679514",
            "telephone_number": "253-509-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3497 BETHEL RD SE",
            "city": "PORT ORCHARD",
            "state": "WA",
            "postal_code": "983665634",
            "telephone_number": "360-874-9063",
            "fax_number": "360-874-0071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALMART",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-14",
        "last_updated": "2014-08-14",
        "status": "A",
        "authorized_official_last_name": "JENKINS",
        "authorized_official_first_name": "MICAJAH",
        "authorized_official_title_or_position": "PHARMACIST",
        "authorized_official_telephone_number": "253-509-2176"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pharmacist",
            "state": "WA",
            "license": "PH60031151",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACIST LICENSE",
            "identifier": "PH60031151",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Ross Wagner, RPH
• Wal-Mart Stores Inc (Vision Center 30-2325)
• Walgreen Co (Walgreens #05698)
• Erica Walker
• Sandra Mae Walker, PT
• Walmart Inc. (Walmart Pharmacy 10-2325)
• Tedd G Walt, LMHC
• Celeste Michele Wandke
• David L Wang, DO
• Blake Warner, LMP

• Pharmacist in Port Orchard, WA
• Providers in Port Orchard, WA by specialty
• Pharmacist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.