Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-mart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
RANDY WRIGHT (PHY ENROLLMENT SPECIALIST)
(479) 273-6574
Entity
Organization
Contact information
Practice address
3255 LA HIGHWAY 1 S, PORT ALLEN, LA 70767-5858
(225) 749-7454
(225) 749-7418
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
4788RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1269930
—
LA
01
—
1923110
NCPDP NUMBER
LA
Enumeration date
09/25/2006
Last updated
07/03/2008
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