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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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