Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3756
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DR. HEALTHCARE & ENROLLMENT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
124 E COLUMBIA ST, OKEMAH, OK 74859-2801
(918) 623-9207
(918) 623-9221
Mailing address
702 SW 8TH ST, 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
51-6875
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100816310F
—
OK
01
—
2149232
PK
—
Enumeration date
10/09/2014
Last updated
04/01/2015
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