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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-2345
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
721 DALE EVANS DR, ITALY, TX 76651-3847
(972) 483-1258
(972) 483-1290
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
29372
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669876306
—
TX
01
—
2148715
PK
—
Enumeration date
10/09/2014
Last updated
01/07/2016
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