# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WALMART PHARMACY 10-0629
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104843366
- **Authorized official:** SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
- **Authorized official phone:** (479) 277-2500

## Contact information

- **Practice address:** 513 N DUNCAN BYP STE A, UNION, SC 29379-8682
- **Practice address phone:** (864) 427-6114
- **Practice address fax:** (864) 427-6114
- **Mailing address:** 702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 258-6180

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 2483 | SC | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 08/24/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2090155 | PK | — |
| 05 | — | 724831 | — | SC |
| 05 | — | DE3740 DME | — | SC |