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Organization
WAL-MART STORES INC
Active
Organization
WAL-MART STORES INC
Active
Other names
WAL-MART PHARMACY 10-2301
Organization subpart
No
Provider details
NPI number
Authorized official
DIANNA M PAINTER (PHARMACY ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
1900 WOODLAND DR, COOS BAY, OR 97420-2045
(541) 267-5311
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
3336C0003X
Community/Retail Pharmacy
Primary
0000745CS
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
124243
—
OR
01
—
292968
MEDICAID-DME
OR
01
—
3811444
OTHER ID NUMBER-COMMERCIAL NUMBER
—
Enumeration date
07/19/2006
Last updated
12/24/2008
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