Organization
WAL-MART PHARMACY INC WEST
Active
Parent organization
WAL-MART STORES INC
Other names
WAL-MART PHARMACY
Organization subpart
Yes
Provider details
NPI number
Legal business name
WAL-MART STORES INC
Authorized official
DIANNA PAINTER (PHY ENROLLMENT SPECIALIST)
(479) 277-1238
Entity
Organization
Contact information
Practice address
930 MOUNT PROSPECT PLZ, MT PROSPECT, IL 60056-2652
(847) 590-0011
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54011097
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1460889
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
07/16/2006
Last updated
02/02/2009
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