Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3863
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
2795 HIGHWAY 371 N, MANTACHIE, MS 38855-9114
(662) 282-4180
(662) 282-4182
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8705
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13593/ 1.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08759722
—
MS
01
—
2147552
PK
—
Enumeration date
08/22/2014
Last updated
12/29/2015
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