Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY 10-3496
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
5825 W HOPE AVE, MILWAUKEE, WI 53216-1275
(414) 445-3959
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
8219042
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2109993
PK
—
05
—
33263000
—
WI
Enumeration date
07/16/2006
Last updated
07/10/2013
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