Organization
WAL-MART STORES INC
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY 10-0208
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
2970 MILITARY AVE, BAXTER SPRINGS, KS 66713-2331
(620) 856-5196
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
209550
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100433160B
—
KS
01
—
2025972
PK
—
05
—
6010831836
—
KS
Enumeration date
07/16/2006
Last updated
07/10/2013
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