Organization
WAL-MART STORES INC
Active
Other names
Walmart Pharmacy 10-3819
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
8848 N HIGHWAY 59, VAN BUREN, AR 72956-7903
(479) 471-1762
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20780
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206913407
—
AR
01
—
2148074
PK
—
Enumeration date
09/19/2014
Last updated
12/22/2015
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