Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-2529
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
2021 LYNNHAVEN PKWY, VIRGINIA BEACH, VA 23456-1410
(757) 416-3490
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
0201003417
VA
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008509522
—
VA
01
—
2107235
PK
—
05
—
8509522
—
VA
Enumeration date
07/16/2006
Last updated
05/15/2024
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