Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-2483
Organization subpart
No
Provider details
NPI number
Authorized official
DEB LAUVER (SPECIALIST PLAN ENROLLMENT)
(479) 258-2115
Entity
Organization
Contact information
Practice address
6973 BLUE DIAMOND RD, LAS VEGAS, NV 89178-9213
(702) 408-3596
(702) 408-3597
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH03796
NV
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710407895
—
NV
01
—
2170422
PK
—
Enumeration date
06/21/2017
Last updated
08/29/2023
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