Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-7339
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIR HEALTHCARE CONTRACT & ENROLLMEN)
(479) 204-8550
Entity
Organization
Contact information
Practice address
5303-A WRIGHTSBORO RD, AUGUSTA, GA 30813-0000
(762) 383-6527
(762) 383-6526
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PHRE010353
GA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2166574
PK
—
Enumeration date
10/20/2016
Last updated
04/28/2017
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