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General NPI Number Information
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NPI Number | 1568489730
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Entity Type | Organization
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Legal Business Name | WAL-MART STORES EAST LP
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Dates
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Enumeration Date | 07/16/2006
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Last Update Date | 02/28/2008
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Provider Practice Location Address
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Address Line | 5000 AMERICAN WAY
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City | MEMPHIS
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State | TN
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Zip | 38115-1573
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Country | US
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Telephone | 901-366-6274
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Fax |
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Provider Business Mailing Address
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Address Line | 702 SW 8TH ST
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City | BENTONVILLE
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State | AR
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Zip | 72716-6209
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHY ENROLLMENT SPECIALIST
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Name | RANDY WRIGHT
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Credential |
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Telephone | 479-273-6574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | C1784
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License Number State | TN
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