# 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 10-2640
- **Organization subpart:** No

## Provider details

- **NPI number:** 1922025238
- **Authorized official:** MATTHEW MCMULLIN (DIRECTOR)
- **Authorized official phone:** (479) 371-8711

## Contact information

- **Practice address:** 450 HIGHLAND AVE, SALEM, MA 01970-1765
- **Practice address phone:** (978) 825-0845
- **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 | CS2813 | MA | Yes |

## Other

- **Enumeration date:** 07/16/2006
- **Last updated:** 05/29/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0447013 | — | MA |
| 01 | — | 2038379 | PK | — |
| 05 | — | 447013 | — | MA |