Organization
WAL-MART STORES INC
Active
Other names
Walmart Pharmacy 10-2601
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIRECTOR OF HEALTHCARE CONTRAC)
(479) 204-8550
Entity
Organization
Contact information
Practice address
814 W MAIN ST, CHARLESTON, AR 72933-8907
(479) 965-8503
(479) 965-8506
Mailing address
702 SW 8TH STREET, BENTONVILLE, AR 72712
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
AR20789
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207322407
—
AR
01
—
2149059
PK
—
Enumeration date
10/07/2014
Last updated
12/21/2015
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