Organization
WAL-MART STORES INC
Active
Other names
Wal-Mart Pharmacy 10-3369
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTH CARE ENROLLMENT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
900 E ROSS ST, CLEARWATER, KS 67026-7849
(620) 584-4042
(620) 584-4044
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 273-4885
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
2-13051
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148263
PK
—
Enumeration date
10/07/2014
Last updated
06/13/2016
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