# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Wal-Mart Pharmacy 10-2235
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730588104
- **Authorized official:** LAURA LEVINE (DIR HEALTHCARE CONTRACT&ENROLL)
- **Authorized official phone:** (479) 204-8550

## Contact information

- **Practice address:** 6361 HIGHWAY 72 EAST, GURLEY, AL 35748
- **Practice address phone:** (256) 776-4404
- **Practice address fax:** (479) 277-4331
- **Mailing address:** 702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 277-2500
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 114431 | AL | Yes |

## Other

- **Enumeration date:** 08/21/2014
- **Last updated:** 02/02/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 167487 | — | AL |
| 01 | — | 2147623 | PK | — |