| Organization Name: | WAL-MART STORES EAST, LP |
| NPI Number: | 1073985404 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LAURA LEVINE (DIR HEALTHCARE CONTRACT&ENROLM) |
| Mailing Address: | 3031 Mid Rivers Mall Dr Saint Peters |
| State: | MO US |
| Postal Code: | 633762162 |
| Phone Number: | 6366971051 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2015 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |