Organization
WALMART PHARMACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARIA C TANGONAN PHARMD (PHARMACY CLINICAL SERVICES MANAGER)
(708) 890-0106
Entity
Organization
Contact information
Practice address
1424 W 47TH ST, CHICAGO, IL 60609-3232
(773) 475-4462
(773) 475-4463
Mailing address
1424 W 47TH ST, CHICAGO, IL 60609-3232
(773) 475-4462
(773) 475-4463
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
051297740
IL
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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