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Organization
WAL-MART STORES TEXAS LLC
Active
Organization
WAL-MART STORES TEXAS LLC
Active
Other names
Walmart Pharmacy 10-2410
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
122 COMMERCIAL AVE, ANSON, TX 79501-2000
(325) 823-2483
(325) 823-2517
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
29339
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2147802
PK
—
05
—
467051
—
TX
Enumeration date
09/09/2014
Last updated
01/07/2016
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