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Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-6180
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (MANAGER GOVT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
86 5TH ST NW, ATLANTA, GA 30308-1031
(404) 249-5007
(404) 249-5009
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
333600000X
Pharmacy
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
PHRE009947
GA
Other
Enumeration date
06/06/2013
Last updated
12/04/2015
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