Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-2235
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT&ENROLL)
(479) 204-8550
Entity
Organization
Contact information
Practice address
6361 HIGHWAY 72 EAST, GURLEY, AL 35748
(256) 776-4404
(479) 277-4331
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
114431
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
167487
—
AL
01
—
2147623
PK
—
Enumeration date
08/21/2014
Last updated
02/02/2015
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