Organization
WAL-MART STORES EAST , LP
Active
Other names
WAL-MART PHARMACY 10-1259
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR)
(479) 371-8711
Entity
Organization
Contact information
Practice address
60 S STEWART RD, CORBIN, KY 40701-4675
(606) 523-2206
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
PO2129
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2031436
PK
—
05
—
5400729900
—
KY
05
—
5402363500
—
KY
Enumeration date
07/16/2006
Last updated
06/06/2024
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