# WAL-MART STORES EAST LP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Pharmacy 10-5090
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609893775
- **Authorized official:** SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
- **Authorized official phone:** (479) 277-2500

## Contact information

- **Practice address:** 1415 LAWRENCE DR, DE PERE, WI 54115-3927
- **Practice address phone:** (920) 336-7168
- **Practice address fax:** (920) 336-7586
- **Mailing address:** 702 SW 8TH ST, BENTONVILLE, AR 72716-6209
- **Mailing address phone:** (479) 204-8550
- **Mailing address fax:** (479) 277-4331

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |
| 333600000X | Pharmacy | — | NULL | — |
| 3336C0003X | Community/Retail Pharmacy | 8315-42 | WI | Yes |
| 3336S0011X | Specialty Pharmacy | — | NULL | — |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 04/15/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 2110078 | PK | — |
| 05 | — | 33270200 | — | WI |