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Organization
WAL-MART STORES INC
Active
Organization
WAL-MART STORES INC
Active
Other names
Wal-Mart Pharmacy 10-4173
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (MANAGER OF GOVERNMENT CONTRACT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
12120 CARSON ST, HAWAIIAN GARDENS, CA 90716-1108
(562) 384-4063
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 273-4885
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
51527
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2140679
PK
—
Enumeration date
06/04/2013
Last updated
10/06/2014
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