Organization
WALMART INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH LITTLE (DIRECTOR OF HEALTHCARE CONTRACTING)
(479) 277-2500
Entity
Organization
Contact information
Practice address
4781 E ROCKTON RD, ROSCOE, IL 61073-8977
(815) 389-4940
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
3336C0003X
Community/Retail Pharmacy
Primary
054016129
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2023352
PK
—
Enumeration date
03/15/2007
Last updated
08/23/2023
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