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NPI Code Detail

MEDICARE: WAL-MART STORES, INC.

MEDICARE: WAL-MART STORES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy

General Provider Information

NPI Number : 1639411937
Entity Type Code : Organization
Provider Name (Legal Business Name) : WAL-MART STORES, INC.
Provider Business Mailing Address
First Line : 702 SW 8TH ST
Second Line :
City : BENTONVILLE
State : AR
Zip : 72716-0445
Country : US
Telephone Number : 479-204-8741
Fax Number :
Provider Business Practice Location Address
First Line : 20120 PINEBROOK BLVD
Second Line :
City : BEND
State : OR
Zip : 97702-2537
Country : US
Telephone Number : 541-389-5440
Fax Number : 541-389-5382
Authorized Official
Title or Position : SPECIALIST PLAN ENROLLMENT
Name : DEB LAUVER
Credential :
Telephone Number : 479-204-8741
Provider Enumeration Date : 03/25/2013
Last Update Date : 03/25/2013

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Directions to “WAL-MART STORES, INC. ” Practice Location

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