Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4590
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH LAUVER (ENROLLMENT SPECIALIST)
(479) 204-8741
Entity
Organization
Contact information
Practice address
3410 SW MARKET ST, LEES SUMMIT, MO 64082
(816) 623-3274
(816) 623-3278
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
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2500037977
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2167520
PK
—
05
—
60042630
—
MO
Enumeration date
11/29/2016
Last updated
08/29/2023
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