# WAL-MART STORES EAST LP

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** WAL-MART PHARMACY 10-116
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154348415
- **Authorized official:** MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
- **Authorized official phone:** (479) 371-8711

## Contact information

- **Practice address:** 929 S PINE ST, VIVIAN, LA 71082-3364
- **Practice address phone:** (318) 375-4510
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-0445

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 4918RC | LA | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 11/06/2023