Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (DIRECTOR OF HEALTHCARE CONTRAC)
(479) 204-8550
Entity
Organization
Contact information
Practice address
920 AVENUE G, KENTWOOD, LA 70444-2635
(985) 229-2905
(985) 229-2906
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1240
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
3336C0003X
Community/Retail Pharmacy
Primary
PHY.007073.RC
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2150299
PK
—
05
—
2203584
—
LA
Enumeration date
02/10/2015
Last updated
07/08/2015
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