# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WAL-MART STORES INC
- **Other names:** Wal-Mart Pharmacy 10-3030
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962768382
- **Legal business name:** WAL-MART STORES INC
- **Authorized official:** LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
- **Authorized official phone:** (479) 204-8550

## Contact information

- **Practice address:** 3850 N 124TH ST, WAUWATOSA, WI 53222-2104
- **Practice address phone:** (414) 203-4367
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 277-1238
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 9127-42 | WI | Yes |

## Other

- **Enumeration date:** 04/10/2012
- **Last updated:** 03/26/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2134721 | PK | — |