Organization
WAL-MART STORES EAST LP
Active
Other names
WAL-MART PHARMACY 10-2717
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
5901 U S HIGHWAY 49, HATTIESBURG, MS 39402-2858
(601) 296-9566
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-6209
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
04612
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05759571
—
MS
01
—
2045907
PK
—
05
—
5759571
—
MS
Enumeration date
07/19/2006
Last updated
08/23/2023
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