Organization
WAL-MART STORES EAST LP
Active
Parent organization
WAL-MART STORES INC
Other names
Wal-Mart Pharmacy 10-3080
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
182 NC 102 W, AYDEN, NC 28513-8792
(450) 435-7437
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11167
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0746078
—
NC
01
—
2132398
PK
—
Enumeration date
10/19/2011
Last updated
08/01/2013
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