Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4267
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT & ENRO)
(479) 204-8550
Entity
Organization
Contact information
Practice address
15726 SE HIGHWAY 19, CROSS CITY, FL 32628-3568
(352) 498-6034
Mailing address
702 SW 8TH ST, MAILSTOP 0445, 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
PH29084
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014865600
—
FL
05
—
014865601 DME
—
FL
01
—
2150862
PK
—
Enumeration date
03/17/2015
Last updated
07/30/2015
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