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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-2363
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
504 W PINE ST, EDGEWOOD, TX 75117-2944
(903) 896-7053
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29515
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148071
PK
—
05
—
467062
—
TX
Enumeration date
09/19/2014
Last updated
04/29/2015
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