# WAL-MART STORES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wal-Mart Pharmacy 10-2075
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639411937
- **Authorized official:** DEB LAUVER (SPECIALIST PLAN ENROLLMENT)
- **Authorized official phone:** (479) 204-8741

## Contact information

- **Practice address:** 20120 PINEBROOK BLVD, BEND, OR 97702-2537
- **Practice address phone:** (541) 389-5440
- **Practice address fax:** (541) 389-5382
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 204-8741

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | — | NULL | Yes |

## Other

- **Enumeration date:** 03/25/2013
- **Last updated:** 03/25/2013