Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-1250
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DR. HEALTHCARE & ENROLLMENT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
9032 HIGHWAY 14, GRAY COURT, SC 29645-4151
(864) 876-1213
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
15587
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148896
PK
—
Enumeration date
10/21/2014
Last updated
05/20/2015
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