Organization
WAL-MART STORES EAST LP
Active
Other names
Wal-Mart Pharmacy 10-3606
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
185 N CHARLES RICHARD BEALL BLVD, DEBARY, FL 32713-2202
(386) 601-0036
(386) 601-0035
Mailing address
702 SW 8TH ST, MAIL STOP 0445, BENTONVILLE, AR 72716-0445
(479) 204-8550
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
Primary
PH30469
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019372600
—
FL
05
—
019372601 DME
—
FL
01
—
2164222
PK
—
Enumeration date
09/07/2016
Last updated
08/29/2023
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