Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY WRIGHT (PHY ENROLLMENT SPECIALIST)
(479) 273-6574
Entity
Organization
Contact information
Practice address
4840 OUTER LOOP, LOUISVILLE, KY 40219-3302
(502) 968-8776
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PO2116
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1819222
OTHER ID NUMBER
—
05
—
5400733100
—
KY
05
—
5402301500
—
KY
Enumeration date
07/16/2006
Last updated
02/28/2008
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