Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3767
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIRECTOR OF HEALTHCARE CONTRAC)
(479) 204-8550
Entity
Organization
Contact information
Practice address
812 N CLARENCE NASH BLVD, WATONGA, OK 73772-2024
(580) 623-5950
(580) 623-5619
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
49-6923
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100800600 B
—
OK
01
—
2149146
PK
—
Enumeration date
10/09/2014
Last updated
12/22/2015
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