Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0817
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
4444 W VINE ST, KISSIMMEE, FL 34746-5315
(407) 397-1002
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 277-1242
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH15403
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034172000
—
FL
05
—
109585400
—
FL
01
—
2007748
PK
—
Enumeration date
07/19/2006
Last updated
06/03/2025
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