Organization
WAL-MART STORES INC
Active
Other names
Wal-Mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
881 W BUCHANAN ST, PRAIRIE GROVE, AR 72753-2880
(905) 873-3021
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20650
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188056407
—
AR
01
—
2129974
PK
—
Enumeration date
04/18/2011
Last updated
12/22/2015
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