# WAL-MART PHARMACY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982158622
- **Authorized official:** ADRIANA RENEE HOUSTON PHARMD (STAFF PHARMACIST)
- **Authorized official phone:** (803) 381-3103

## Contact information

- **Practice address:** 4875 OLD YORK RD, ROCK HILL, SC 29732-8127
- **Practice address phone:** (803) 323-2091
- **Mailing address:** 4875 OLD YORK RD, ROCK HILL, SC 29732-8127
- **Mailing address phone:** (803) 323-2091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/11/2016
- **Last updated:** 08/11/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 36649 | SOUTH CAROLINA PHARMACY LICENSE | SC |