Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2456
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
2310 W MAIN ST, PRAGUE, OK 74864-9537
(405) 567-0410
(405) 567-0997
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
316844
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100816310E
—
OK
01
—
2148055
PK
—
Enumeration date
09/19/2014
Last updated
12/23/2015
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