Organization
WAL-MART STORES EAST LP
Active
Other names
WALMART PHARMACY 10-0107
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW MCMULLIN (DIRECTOR, CONTRACTING)
(479) 371-8711
Entity
Organization
Contact information
Practice address
134 COURTRIGHT RD, MARTIN, TN 38237-1606
(731) 587-3819
(731) 587-2826
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
—
—
3336C0003X
Community/Retail Pharmacy
Primary
C1691
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1454005
—
TN
01
—
2089961
PK
—
Enumeration date
07/16/2006
Last updated
11/06/2023
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