Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4644
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT&ENROL)
(479) 204-8550
Entity
Organization
Contact information
Practice address
7500 UNIVERSITY BOULEVARD, MOON TOWNSHIP, PA 15108-0000
(412) 893-0142
(412) 893-0141
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PP482689
PA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007455310385
—
PA
01
—
2164041
PK
—
Enumeration date
08/28/2016
Last updated
08/29/2023
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