Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-3798
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DR. HEALTHCARE & ENROLLMENT)
(479) 204-8550
Entity
Organization
Contact information
Practice address
7013 S PINE ST, PACOLET, SC 29372-2246
(864) 474-3341
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
15565
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2148882
PK
—
05
—
715565
—
SC
Enumeration date
10/22/2014
Last updated
05/19/2015
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