Healthcare Provider Details

I. General information

NPI: 1669875597
Provider Name (Legal Business Name): WAL-MART STROES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HIGHWAY 124 W
DAMASCUS AR
72039-9251
US

IV. Provider business mailing address

702 SW 8TH ST
BENTONVILLE AR
72716-0445
US

V. Phone/Fax

Practice location:
  • Phone: 501-335-7270
  • Fax: 501-335-7267
Mailing address:
  • Phone: 479-204-8550
  • Fax: 479-277-4331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberAR20788
License Number StateAR

VIII. Authorized Official

Name: LAURA LEVINE
Title or Position: DIR. HEALTHCARE CONTRACTING
Credential:
Phone: 479-204-8550