Organization
WAL-MART STORES EAST, LP
Active
Other names
Walmart Pharmacy 10-3865
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
420 E LEE ST, SARDIS, MS 38666-1236
(662) 487-9001
(662) 487-9003
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8705
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
13604/ 1.2
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09785548
—
MS
01
—
2147561
PK
—
Enumeration date
08/22/2014
Last updated
05/19/2015
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