Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY 10-3811
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
61 PLAZA DRIVE, KIMBALL, WV 24853
(304) 585-7820
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
MP0552327
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2111563
PK
—
05
—
3810003883
—
WV
05
—
552327
—
WV
Enumeration date
07/18/2006
Last updated
07/11/2013
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