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Organization

WAL-MART STORES EAST LP

Active
Other names
Walmart Pharmacy 10-3753
Organization subpart
No

Provider details

NPI number
Authorized official
LAURA LEVINE (DIR. HEALTHCARE CONTRACTING)
(479) 204-8550
Entity
Organization

Contact information

Practice address
620 N HIGHWAY 26, LAKE ARTHUR, LA 70549-3404
(337) 774-3424
(337) 774-3426
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
PHY.007039-RC
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2147979
PK
05
2203487
LA
Enumeration date
09/11/2014
Last updated
12/28/2015
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