Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2462
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
1600 W HIGHWAY 66, STROUD, OK 74079-2804
(918) 968-4049
(918) 968-4476
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
31-6845
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100816310D
—
OK
01
—
2147812
PK
—
Enumeration date
09/09/2014
Last updated
04/08/2015
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