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Organization
WAL-MART STORES INC
Active
Organization
WAL-MART STORES INC
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY 10-2960
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
4101 CRENSHAW BLVD, LOS ANGELES, CA 90008-2501
(323) 299-8246
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY46196
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1997751
PK
—
05
—
463PHA461960
—
CA
Enumeration date
07/16/2006
Last updated
08/27/2013
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