Organization
WALMART PHARMACY
Active
Other names
Wal-mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LEANN LEASE PHARMD (STAFF PHARMACIST)
(843) 365-0301
Entity
Organization
Contact information
Practice address
2709 CHURCH ST STE A, CONWAY, SC 29526-4440
(843) 365-0301
Mailing address
2709 CHURCH ST STE A, CONWAY, SC 29526-4440
(843) 365-0301
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202216176
VIRGINIA BOARD OF PHARMACY
VA
01
—
42285
SOUTH CAROLINA BOARD OF PHARMACY
SC
Enumeration date
11/17/2019
Last updated
11/17/2019
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