Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY 10-3306
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
1220 GALLATIN AVE, NASHVILLE, TN 37206-3204
(615) 266-4131
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
4188
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454972
—
TN
01
—
2094718
PK
—
Enumeration date
07/16/2006
Last updated
08/30/2013
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