Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Louisville, KY
NPI 1376560698 · NPPES record last updated Feb 28, 2008
Key facts
- NPI
- 1376560698
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- PO2116 (KY)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 4840 Outer Loop
Louisville, KY 40219-3302 - Phone
- (502) 968-8776
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Randy Wright
- Title
- Phy Enrollment Specialist
- Phone
- (479) 273-6574
Corporate family (same tax ID) 24
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | PO2116 | KY | Yes |
Addresses
Primary practice location
4840 Outer Loop
Louisville, KY 40219-3302
Mailing address
702 SW 8TH St
Bentonville, AR 72716-6209
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1819222 | Other | OTHER ID NUMBER | |
| 5402301500 | Medicaid | KY | |
| 1819222 | Other | OTHER ID NUMBER-COMMERCIAL NUMBER | |
| 5400733100 | Medicaid | KY |
Other names
- WAL-MART PHARMACY
Other providers in Louisville, KY
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
- Wal-Mart Stores East LP
All providers in Louisville, KY · Community/Retail Pharmacy in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.