Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3036
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA LEVINE (MGR OF GOVERNMENT CONTRACTING)
(479) 204-8550
Entity
Organization
Contact information
Practice address
1593 NC HIGHWAY 86 N, YANCEYVILLE, NC 27379-8650
(336) 694-1627
(336) 694-1226
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
11131
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2132395
PK
—
Enumeration date
10/19/2011
Last updated
04/22/2015
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