Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT MCMULLIN (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
12300 ROUTE 47, HUNTLEY, IL 60142-9634
(847) 669-7563
(847) 669-7609
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1238
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
54016646
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2119429
PK
—
05
—
=========
—
IL
Enumeration date
03/05/2009
Last updated
08/23/2023
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