Organization
WAL-MART STORES EAST LP
Active
Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY WRIGHT (PHY ENROLLMENT SPECIALIST)
(479) 273-6574
Entity
Organization
Contact information
Practice address
5000 AMERICAN WAY, MEMPHIS, TN 38115-1573
(901) 366-6274
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
C1784
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454064
—
TN
01
—
4422969
OTHER ID NUMBER
—
Enumeration date
07/16/2006
Last updated
02/28/2008
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