Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
Wal-Mart Pharmacy 10-3257
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
LAURA LEVINE (MANAGER GOVT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
112 N MAIN ST, BROADWAY, NC 27505-9522
(919) 258-0752
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
11580
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154769537
—
NC
01
—
2140952
PK
—
Enumeration date
06/07/2013
Last updated
04/30/2014
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