Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-2165
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACT&ENROL)
(479) 204-8550
Entity
Organization
Contact information
Practice address
952 E LAWRENCE HARRIS HWY, SLOCOMB, AL 36375-5350
(334) 886-9500
(334) 886-9506
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
114434
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1770982217
—
AL
01
—
2148085
PK
—
Enumeration date
08/21/2014
Last updated
03/02/2015
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