Organization
WAL-MART STORES INC
Active
Other names
Walmart Pharmacy 10-2578
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
3500 MULBERRY HIGHWAY 64 W, MULBERRY, AR 72947-8952
(479) 997-8895
(479) 997-8897
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
AR20779
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206916407
—
AR
01
—
2148054
PK
—
Enumeration date
09/19/2014
Last updated
12/21/2015
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