Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3769
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT & ENRO)
(479) 204-8550
Entity
Organization
Contact information
Practice address
3530 CATHEDRAL CAVERNS HWY, GRANT, AL 35747-9268
(256) 728-4018
(256) 728-4019
Mailing address
702 SW 8TH ST, MAILSTOP 0445, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
114424
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629477096
—
AL
05
—
166695
—
AL
01
—
2147651
PK
—
Enumeration date
08/21/2014
Last updated
01/08/2015
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