Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4647
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIRECTOR, HEALTHCARE CONTRACTI)
(479) 204-8550
Entity
Organization
Contact information
Practice address
515 3RD STREET, INDEPENDENCE, LA 70443
(985) 878-2078
(985) 878-9233
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007132-RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2151043
PK
—
05
—
2203771
—
LA
Enumeration date
03/23/2015
Last updated
09/23/2015
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