Organization
WALMART INC.
Active
Other names
Walmart Pharmacy 10-5003
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
211 ASPEN VILLAGE DR, PAGOSA SPRINGS, CO 81147-9170
(970) 731-9017
(970) 731-9018
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 258-2115
(479) 277-4331
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PDO.1680000089
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104215540
—
CO
01
—
2149814
PK
—
Enumeration date
01/22/2015
Last updated
09/19/2025
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