Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4294
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DR. HEALTHCARE & ENROLLMENT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
516 W VETERANS BLVD, DERMA, MS 38839
(662) 628-5100
(662) 628-5102
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13634/1.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08156073
—
MS
01
—
2149228
PK
—
Enumeration date
09/05/2014
Last updated
06/27/2015
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