NPIViewer - Provider NPI 1215956222

NPI:	1215956222
Name:	WAL-MART STORES TEXAS LLC
Entity type:	Organization
Organization Name:	WAL-MART STORES TEXAS LLC
Other - Org Name:	<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:	DIRECTOR OF HEALTHCARE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:	SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:	LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:	479-277-2500
Mailing Address - Street 1:	702 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:	BENTONVILLE
Mailing Address - State:	AR
Mailing Address - Zip Code:	72716-0445
Mailing Address - Country:	US
Mailing Address - Phone:	479-277-1258
Mailing Address - Fax:	479-277-4331
Practice Address - Street 1:	1025 W TRINITY MILLS RD
Practice Address - Street 2:
Practice Address - City:	CARROLLTON
Practice Address - State:	TX
Practice Address - Zip Code:	75006-1375
Practice Address - Country:	US
Practice Address - Phone:	800-273-3455
Practice Address - Fax:	800-406-8976
EIN:	<UNAVAIL>
Is Organization Subpart?:	No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:	2006-07-19
Last Update Date:	2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:

Primary?	Code	Type	Classification	Specialization
Yes	3336C0003X	Suppliers	Pharmacy	Community/Retail Pharmacy

State	Identifier ID	ID Type	Issuer
TX	200538680A	Medicaid
WV	3810011244	Medicaid
TX	613556	Medicaid
TX	PH386	Medicaid
AR	166999407	Medicaid
	2095511	Other	PK
TX	1215956222	Medicaid
WA	6031421	Medicaid
NJ	0162973	Medicaid
TX	0162973	Medicaid
TX	100243640D	Medicaid
PA	1020965500001	Medicaid
MT	1215956222	Medicaid
KY	7100037990	Medicaid
TN	4582517	Medicaid
TX	470020	Medicaid
SC	7T2283	Medicaid
VA	1215956222	Medicaid
AR	166999407	Medicaid