Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-4633
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIRECTOR, HEALTHCARE CONTRACTI)
(479) 204-8550
Entity
Organization
Contact information
Practice address
19250 E HIGHWAY 66, LUTHER, OK 73054-7004
(405) 277-9345
(405) 277-9350
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
1-7176
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100243650C
—
OK
01
—
2151026
PK
—
Enumeration date
03/19/2015
Last updated
09/02/2015
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