Organization
WAL-MART STORES EAST LP
Active
Other names
Walmart Pharmacy 10-0110
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
16313 NEW INDEPENDENCE PKWY, WINTER GARDEN, FL 34787-8113
(407) 554-0181
Mailing address
702 SW 8TH ST, 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
PH30397
FL
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
019225300
—
FL
05
—
019225301 DME
—
FL
01
—
2164048
PK
—
Enumeration date
09/01/2016
Last updated
11/06/2023
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