Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
Wal-Mart Pharmacy 10-3031
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
N88W15559 MAIN ST, MENOMONEE FALLS, WI 53051-3156
(262) 509-5708
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
9166-42
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2136758
PK
—
Enumeration date
09/04/2012
Last updated
03/26/2014
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