Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-2303
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (MANAGER OF GOV. CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
333 N MAIN ST, WEST HARTFORD, CT 06117-2506
(860) 509-1708
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-2500
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PCY.0002258
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008043894
—
CT
01
—
2138385
PK
—
Enumeration date
12/20/2012
Last updated
12/22/2015
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